Overview:Surgical management of benign prostatic hyperplasia(BPH)has evolved significantly,incorporating various minimally invasive procedures aimed at reducing morbidity and optimizing patient outcomes.Despite advanc...Overview:Surgical management of benign prostatic hyperplasia(BPH)has evolved significantly,incorporating various minimally invasive procedures aimed at reducing morbidity and optimizing patient outcomes.Despite advancements,transurethral approaches continue to pose risks such as urethral strictures and urinary incontinence due to mechanical and thermal stress.To address these limitations,the Suprapubic Transvesical Adenoma Resection of the Prostate(STARP)was developed,offering a direct suprapubic route that bypasses the urethra entirely.Recent studies have validated STAR-P as both feasible and safe,emphasizing advantages such as enhanced visualization of the urinary sphincter,minimized urethral trauma,effective hemostasis,and reduced operative stress.The procedure utilizes specially designed instrumentation,including a large-caliber bipolar resectoscope(42 Fr),allowing the efficient removal of substantial adenoma tissue in fewer resection passes compared to traditional methods.Objectives:This article provides a comprehensive,step-by-step description of the STAR-P technique.The primary objective is to detail patient selection criteria,preoperative assessments,procedural steps including mini-open suprapubic access,specialized instrumentation usage,resection techniques,and postoperative management protocols.Highlighting technical considerations and procedural innovations aims to inform urologists about the potential benefits of STAR-P,particularly in patients at higher risk for urethral complications or those with large prostate volumes.By documenting the procedural intricacies and outcomes clearly and thoroughly,we seek to encourage informed adoption of STAR-P as an alternative,effective surgical approach for managing benign prostatic hyperplasia,thus contributing to the evolving landscape ofminimally invasive urological surgery.展开更多
The transurethral route is the access of choice for benign prostatic hyperplasia(BPH)surgical treatment.Transurethral resection of the prostate(TURP)has been the gold standard in surgical intervention for BPH;however,...The transurethral route is the access of choice for benign prostatic hyperplasia(BPH)surgical treatment.Transurethral resection of the prostate(TURP)has been the gold standard in surgical intervention for BPH;however,the advent of novel surgical techniques and the exploration of new energy sources in recent decades have seen this primacy contested.Nevertheless,the transurethral route harbors numerous challenges and pitfalls that can pose significant risks even for the most experienced endoscopic urologists.Complications associated with transurethral access are well documented yet often underestimated by endoscopic surgeons,primarily because the pathological conditions arising from transurethral surgery typically fall within the realm of those specializing in genitourinary reconstructive surgery.This narrative review describes and critically discusses the specific pitfalls associated with transurethral surgery for BPH.Urethral strictures,transient or permanent postoperative incontinence,reintervention,and de novo/persistent lower urinary tract symptoms(LUTS)represent the main complications of transurethral treatments for BPH.These problems still stand as the foremost challenge for all endoscopists despite recent technological advancements.The use of increasingly miniaturized instruments,more mindful energy application,sphincter-sparing enucleation techniques,and the advent of so-called minimally invasive surgical techniques(MISTs)all contribute to a more conscious and anatomically respectful transurethral approach.An endoscopic transvesical suprapubic access may be another alternative strategy to minimize the complications of transurethral route in the future.展开更多
文摘Overview:Surgical management of benign prostatic hyperplasia(BPH)has evolved significantly,incorporating various minimally invasive procedures aimed at reducing morbidity and optimizing patient outcomes.Despite advancements,transurethral approaches continue to pose risks such as urethral strictures and urinary incontinence due to mechanical and thermal stress.To address these limitations,the Suprapubic Transvesical Adenoma Resection of the Prostate(STARP)was developed,offering a direct suprapubic route that bypasses the urethra entirely.Recent studies have validated STAR-P as both feasible and safe,emphasizing advantages such as enhanced visualization of the urinary sphincter,minimized urethral trauma,effective hemostasis,and reduced operative stress.The procedure utilizes specially designed instrumentation,including a large-caliber bipolar resectoscope(42 Fr),allowing the efficient removal of substantial adenoma tissue in fewer resection passes compared to traditional methods.Objectives:This article provides a comprehensive,step-by-step description of the STAR-P technique.The primary objective is to detail patient selection criteria,preoperative assessments,procedural steps including mini-open suprapubic access,specialized instrumentation usage,resection techniques,and postoperative management protocols.Highlighting technical considerations and procedural innovations aims to inform urologists about the potential benefits of STAR-P,particularly in patients at higher risk for urethral complications or those with large prostate volumes.By documenting the procedural intricacies and outcomes clearly and thoroughly,we seek to encourage informed adoption of STAR-P as an alternative,effective surgical approach for managing benign prostatic hyperplasia,thus contributing to the evolving landscape ofminimally invasive urological surgery.
文摘The transurethral route is the access of choice for benign prostatic hyperplasia(BPH)surgical treatment.Transurethral resection of the prostate(TURP)has been the gold standard in surgical intervention for BPH;however,the advent of novel surgical techniques and the exploration of new energy sources in recent decades have seen this primacy contested.Nevertheless,the transurethral route harbors numerous challenges and pitfalls that can pose significant risks even for the most experienced endoscopic urologists.Complications associated with transurethral access are well documented yet often underestimated by endoscopic surgeons,primarily because the pathological conditions arising from transurethral surgery typically fall within the realm of those specializing in genitourinary reconstructive surgery.This narrative review describes and critically discusses the specific pitfalls associated with transurethral surgery for BPH.Urethral strictures,transient or permanent postoperative incontinence,reintervention,and de novo/persistent lower urinary tract symptoms(LUTS)represent the main complications of transurethral treatments for BPH.These problems still stand as the foremost challenge for all endoscopists despite recent technological advancements.The use of increasingly miniaturized instruments,more mindful energy application,sphincter-sparing enucleation techniques,and the advent of so-called minimally invasive surgical techniques(MISTs)all contribute to a more conscious and anatomically respectful transurethral approach.An endoscopic transvesical suprapubic access may be another alternative strategy to minimize the complications of transurethral route in the future.
