METHODS OF PROSTATE BED RECONSTRUCTION DURING LAPAROSCOPIC PROSTATECTOMY IN PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA

Aim

To present and substantiate techniques for reconstruction of the prostatic bed during laparoscopic prostatectomy in patients with benign prostatic hyperplasia (BPH), aimed at preventing bladder neck stricture, improving hemostasis, reducing the volume of the prostatic bed, and accelerating its regeneration, as well as to compare the immediate and long-term outcomes of open and laparoscopic retropubic prostatectomy in patients with large BPH.

Materials And Methods

The study included 320 patients with BPH and prostate volume greater than 80 mL treated between 2021 and 2026. Laparoscopic extraperitoneal transcapsular prostatectomy was performed in 200 patients, while 120 patients underwent open retropubic prostatectomy. Several techniques for prostatic bed reconstruction were developed and applied according to the anatomical characteristics of hyperplastic prostatic nodules, the size of the prostatic bed, and the diameter of the bladder neck. Reconstruction methods included bladder neck trigonization using U-shaped and V-shaped sutures, formation of a wide vesicourethral anastomosis, and techniques for reducing the size of large prostatic bed. All patients underwent comprehensive clinical, laboratory, and instrumental evaluation, including assessment of urodynamic parameters. Intraoperative and postoperative complications were classified according to the Clavien-Dindo system. Statistical analysis was performed using Student’s t-test and the Mann-Whitney U test.

Results

The mean operative time was 117.4±10.8 minutes for laparoscopic prostatectomy and 81.1±17.4 minutes for open surgery. However, mean intraoperative blood loss was significantly lower in the laparoscopic group (117.5±30.6 mL vs. 520.5±67.4 mL; p<0.05). The average postoperative hospital stay was 6.0±1.2 days and 9.8±2.9 days, respectively. Blood transfusion was required in 7.5% of patients after open prostatectomy and in none of the patients after laparoscopic surgery. The rate of in-hospital complications was 3.5% following laparoscopic intervention compared with 33.3% after open surgery. Restoration of voiding function, assessed by maximum urinary flow rate, was equally effective in both groups. During a three-year follow-up period, long-term complications occurred in 2.6% of patients after laparoscopic prostatectomy and in 8.0% after open surgery (p<0.05). The proposed reconstruction techniques effectively prevented bladder neck stricture formation, reduced the risk of infectious and inflammatory complications, and improved postoperative healing.

Conclusions

Laparoscopic extraperitoneal retropubic prostatectomy combined with differentiated techniques of prostatic bed reconstruction is an effective and safe surgical treatment for large BPH. The proposed reconstructive methods improve hemostasis, reduce the size of the prostatic bed, prevent bladder neck stricture, and are associated with lower rates of both early and long-term complications compared with open retropubic prostatectomy.