Modified laparoscopic simple prostatectomy combined with temporary internal iliac arteries clamping and urethrocystoanastomosis for large-volume benign prostatic hyperplasia: evaluation of efficacy and safety

Introduction. Laparoscopic simple prostatectomy is the method of choice for surgical treatment of large-volume benign prostatic hyperplasia (BPH). However, the existing limitations of standard approaches are the reason for the development of new modifications.

Objective. To evaluate the efficacy and safety of a modified laparoscopic simple prostatectomy (LSP), supplemented by temporary internal iliac arteries (IIA) clamping and vesicourethral anastomosis (VUA).

Materials & methods. This multicenter open study included 195 patients (mean age 68.1 ± 6.4 years) who underwent LSP combined with temporary IIA clamping and VUA. The primary efficacy criterias during one follow-up year were the severity of urinary symptoms (IPSS), quality of life, maximum flow rate and post-void residual volume. All complications that developed during the 12-month postoperative follow-up period were registered. Statistical calculations were performed using IBM SPSS 23.2 software.

Results. The average surgery time was 91.5 ± 23.2 minutes. Complications of Clavien-Dindo I, II, III grades were noted in 1.0%, 1.0% and 3.6% of patients, respectively; no complications of group IV developed. The mean bed-days were 5.2 ± 1.5 days, the decrease in hemoglobin was 0.6 ± 1.1 g/dL. No patient needed to use an irrigation system. Based on the results of 12 months postoperative follow-up, positive dynamics was established for average IPSS score (p = 0.003), QoL (p = 0.035), maximum urine flow rate (p = 0.012), residual urine volume (p = 0.004). The maximum urine flow rate one year after surgery reached 24.6 ± 2.8 ml/s, the post-void residual urine volume was 15.1 ± 11.9 ml, the average IPSS score was 9.1 ± 1.5, and the QoL score – 1.0 ± 0.7. During the 12-month follow-up period, a low amount of long-term complications was noted in 4 (2.1%) cases: 3 (1.6%) patients had stress urinary incontinence, 1 (0.5%) patient had bladder neck contracture.

Conclusion. Modified LSP combined with temporary IIA clamping and VUA is associated with favorable efficacy and safety profile of the intervention in patients with large-volume BPH.

1. Berry SJ, Coffey DS, Walsh PC, Ewing LL. The development of human benign prostatic hyperplasia with age. J Urol. 1984 Sep;132(3):474-9. doi: 10.1016/s0022-5347(17)49698-4

2. Miernik A, Gratzke C. Current Treatment for Benign Prostatic Hyperplasia. Dtsch Arztebl Int. 2020 Dec 4;117(49):843-854. doi: 10.3238/arztebl.2020.0843

3. İbis MA, Cayan S, Tokatli Z, Orhan İ, Ascı R, Kocamanoglu F, Akbay E, Yaman O. Trends in benign prostatic hyperplasia surgery over the years: A multicenter 14-year retrospective study. Turk J Urol. 2021;47(6):501-508. DOI: 10.5152/tud.2021.21262

4. EAU Guidelines. Edn. presented at the EAU Annual Congress Milan 2023. ISBN 978-94-92671-19-6

5. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187-96. DOI: 10.1097/SLA.0b013e3181b13ca2

6. Shrestha R, Shrestha S, Sitaula S, Basnet P. Anatomy of Internal Iliac Artery and Its Ligation to Control Pelvic Hemorrhage. JNMA J Nepal Med Assoc. 2020;58(230):826-830. DOI: 10.31729/jnma.4958

7. Kelly H. Ligation of both internal iliac arteries for haemorrhage in hysterectomy for carcinoma uterus. John Hopkins Med Journal. 1894;5:53-4. DOI: 10.1097/00000658-189407000-00039

8. Burchell RC. Physiology of internal iliac artery ligation. J Obstet Gynaecol Br Commonw. 1968;75(6):642-51. DOI: 10.1111/j.1471-0528.1968.tb00175.x

9. Mengert WF, Burchell RC. Internal iliac artery ligation: a series of 200 patients. J Int Fed Obstet Gynecol. 1969;7:85. DOI: 10.1002/j.1879-3479.1969.tb00038.x

10. Yang Z, Yang Y, Yin Z, Yao J. The role of internal iliac artery intraoperative vascular clamp temporary occlusion in abnormally invasive placenta. Int J Gynaecol Obstet. 2022;10.1002/ijgo.14422. DOI: 10.1002/ijgo.14422

11. Dursun P. Use of bulldog vascular clamps to reduce intraoperative bleeding during cesarean hysterectomy for placenta percreta. Int J Gynaecol Obstet. 2018;140(3):379-380. DOI: 10.1002/ijgo.12302

12. Ito H, Yamaguchi K, Kotake T, Suzuki F, Miura N. Modified method of radical retropubic prostatectomy for localized prostatic cancer. Int Urol Nephrol. 1992;24(3):283-90. DOI: 10.1007/BF02549537

13. Clark R, Fan S, Navaratnam R, Punjani N, Power N. To clamp or not to clamp? Early venous and arterial vascular control improves blood loss in open radical prostatectomy. UWOMJ. 2020;88(2):9-11. DOI: 10.5206/uwomj.v88i2.7217

14. Takeuchi T, Zaitsu M, Mikami K, Yui S, Takeshima Y, Okamoto N, Imao S. Transient occlusion of bilateral internal iliac arteries facilitates bloodless operative field in subcapsular prostatectomy. Case Rep Med. 2012;2012:812615. DOI: 10.1155/2012/812615

15. Sergi F, Falavolti C, Bove AM, Buscarini M. Robotic-assisted laparoscopic simple prostatectomy and bladder diverticulectomy with temporary clamping of internal iliac arteries. J Robot Surg. 2014;8(1):81-83 DOI: 10.1007/s11701-012-0390-z

16. Sotelo R, Clavijo R, Carmona O, Garcia A, Banda E, Miranda M, Fagin R. Robotic simple prostatectomy. J Urol. 2008;179(2):513-5. DOI: 10.1016/j.juro.2007.09.065

17. Waigankar SS, Yuvaraja TB, Dev P, Agarwal V, Pednekar AP, Kulkarni B. Robotic Freyer's prostatectomy: Operative technique and single-center experience. Indian J Urol. 2021;37(3):247-253. DOI: 10.4103/iju.IJU_78_21

18. Lombardo R, Zarraonandia Andraca A, Plaza Alonso C, González-Dacal JA, Rodríguez Núñez H, Barreiro Mallo A, Gentile BC, Tema G, Albanesi L, Mavilla L, Baldassarri V, De Nunzio C, Tubaro A, Ruibal Moldes M, Giulianelli R. Laparoscopic simple prostatectomy vs bipolar plasma enucleation of the prostate in large benign prostatic hyperplasia: a two-center 3-year comparison. World J Urol. 2021;39(7):2613-2619. DOI: 10.1007/s00345-020-03512-5

19. Tobias-Machado M, Pazeto CL, Faria EF, Dauster B, Genes WEP, Nishimoto RH. Robot-assisted Simple Prostatectomy with Tunnel-Shaped Trigonization (RASP-TST) - A Novel Technique. Int Braz J Urol. 2019;45(4):858. DOI: 10.1590/S1677-5538.IBJU.2018.0611

20. Kaouk J, Sawczyn G, Wilson C, Aminsharifi A, Fareed K, Garisto J, Lenfant L. Single-Port Percutaneous Transvesical Simple Prostatectomy Using the SP Robotic System: Initial Clinical Experience. Urology. 2020;141:173-177. DOI: 10.1016/j.urology.2020.02.024

21. Chavali JS, Garisto J, Bertolo R, Agudelo J, Kaouk JH. Surgical Hints for Robot-Assisted Transvesical Simple Prostatectomy. Urology. 2018;122:185. DOI: 10.1016/j.urology.2018.09.006

22. Cacciamani G, Medina L, Ashrafi A, Landsberger H, Winter M, Mekhail P, Desai M, Aron M, Berger A. Transvesical robot-assisted simple prostatectomy with 360° circumferential reconstruction: step-by-step technique. BJU Int. 2018;122(2):344-348. DOI: 10.1111/bju.14203

23. Coelho RF, Chauhan S, Sivaraman A, Palmer KJ, Orvieto MA, Rocco B, Coughlin G, Patel VR. Modified technique of robotic-assisted simple prostatectomy: advantages of a vesico-urethral anastomosis. BJU Int. 2012;109(3):426-33. DOI: 10.1111/j.1464-410X.2011.010401.x

24. Al-Aown A, Liatsikos E, Panagopoulos V, Kyriazis I, Kallidonis P, Georgiopoulos I, Vasilas M, Jens-Uwe S. Laparoscopic simple prostatectomy: A reasonable option for large prostatic adenomas. Urol Ann. 2015;7(3):297-302. DOI: 10.4103/0974-7796.156144

25. Autorino R, Zargar H, Mariano MB, Sanchez-Salas R, Sotelo RJ, Chlosta PL, Castillo O, Matei DV, Celia A, Koc G, Vora A, Aron M, Parsons JK, Pini G, Jensen JC, Sutherland D, Cathelineau X, Nuñez Bragayrac LA, Varkarakis IM, Amparore D, Ferro M, Gallo G, Volpe A, Vuruskan H, Bandi G, Hwang J, Nething J, Muruve N, Chopra S, Patel ND, Derweesh I, Champ Weeks D, Spier R, Kowalczyk K, Lynch J, Harbin A, Verghese M, Samavedi S, Molina WR, Dias E, Ahallal Y, Laydner H, Cherullo E, De Cobelli O, Thiel DD, Lagerkvist M, Haber GP, Kaouk J, Kim FJ, Lima E, Patel V, White W, Mottrie A, Porpiglia F. Perioperative Outcomes of Robotic and Laparoscopic Simple Prostatectomy: A European-American Multi-institutional Analysis. Eur Urol. 2015;68(1):86-94. DOI: 10.1016/j.eururo.2014.11.044

26. Baumert H, Ballaro A, Dugardin F, Kaisary AV. Laparoscopic versus open simple prostatectomy: a comparative study. J Urol. 2006;175(5):1691-4. DOI: 10.1016/S0022-5347(05)00986-9

27. Varkarakis I, Kyriakakis Z, Delis A, Protogerou V, Deliveliotis C. Long-term results of open transvesical prostatectomy from a contemporary series of patients. Urology. 2004;64(2):306-10. DOI: 10.1016/j.urology.2004.03.033

28. Kuntz RM, Lehrich K, Ahyai SA. Holmium laser enucleation of the prostate versus open prostatectomy for prostates greater than 100 grams: 5-year follow-up results of a randomised clinical trial. Eur Urol. 2008;53(1):160-6. DOI: 10.1016/j.eururo.2007.08.036

29. Eremenko S.N., Eremenko A.N., Mykhaylichenko V.Yu., Dolgopolov V.P., Chernega V.S., Khalilova A.S. Laparoscopic retropubic extraurethral adenomectomy. Urology Herald. 2022;10(2):43-52. (In Russian). DOI: 10.21886/2308-6424-2022-10-2-43-52

30. Seroukhov A.Yu., Pronkin E.A., Glinin K.I., Mamaev I.E. Laparoscopic adenomectomy (preliminary results). Urology Herald. 2016;(1):24-31. (In Russian). DOI: 10.21886/2308-6424-2016-0-1-24-31

31. Krasulin V.V., Gluhov V.P., Vasilev K.S. Surgical treatment of benign prostatic hyperplasia: modern methods and potentials. Urology Herald. 2019;7(2):85-92. (In Russian). DOI: 10.21886/2308-6424-2019-7-2-85-92