Modified plasmakinetic enucleation and resection of the prostate by three glands: proposal of a novel anatomical treatment for benign prostatic hyperplasia

Abstract

Transurethral resection of the prostate (TURP) cannot completely resect hyperplastic tissues and is often associated with high recurrence rate and short recurrence interval. Western and Chinese scholars have reported higher incidences of stress urinary incontinence (SUI) with traditional enucleations. This study investigated the potential applicability of Modified Plasmakinetic Enucleation and Resection of the Prostate by three glands (MPKERP) in treating benign prostatic hyperplasia (BPH). Between April 2020 and June 2021, 28 patients underwent MPKERP for BPH. The surgical procedures included (1) surgical capsule exploration; (2) moderate range enucleation; (3) middle gland enucleation; (4) sector resection at 12 o’clock in the lithotomy position; (5) cut residual distal urethral mucosa; (6) lateral hyperplastic glands enucleation. All 28 patients recovered well after the surgery, and the curative effect was satisfactory. The average operation time was 68.9 ± 21.8 min, the average weight of excised glands was 62.5 ± 19.1 g, the average indwelling catheter time was 4.6 ± 0.6 d, and the average bladder washing time was 28.6 ± 9.5 h. The average postoperative 1-day hemoglobin decrease was 10.2 ± 9.8 g/L. Only one severe hyperplasia patient had transient SUI (incidence rate: 3.6%). No complications, such as urethral stricture, dysuria, urinary incontinence and urinary retention, were reported during follow-up. International Prostate Symptoms Score (IPSS), quality of life (QOL), maximum urinary flow rate (Qmax) and post-void residual volume (PVR) significantly improved three months after surgery (p < 0.0001). The MPKERP can enucleate and resect the hyperplastic glands anatomically in an orderly manner and pay attention to expanding space, reducing resistance, reducing the damage of pushing and pulling, protecting the urethral sphincter complex (USC), and reducing the incidence of urinary incontinence. Altogether, our findings support MPKERP as an improved surgical technique worthy of promotion, and it is more suitable for grass-roots hospitals that lack hardware equipment.