Description of Transperineostomal Resection of the Prostate: A Case Report

TL;DR

A new surgical technique called transperineostomal resection of the prostate is described for treating urinary issues in a patient with a unique medical history.

Contribution

This is the first reported case of transperineostomal bipolar resection of the prostate in the scientific literature.

Findings

The patient experienced significant improvement in urinary symptoms and satisfaction after the procedure.

Post-voiding residual volume decreased dramatically from 150 ml to 15 ml.

The procedure was feasible and safe despite anatomical challenges.

Abstract

We report a case of transperineostomal bipolar resection of the prostate (TPR-P) for lower urinary tract symptoms (LUTS). To our knowledge, this is the first description in the scientific literature. A 67-year-old man with a medical history of multiple penile debridements and formation of a perineostomy due to an episode of severe Fournier’s gangrene in 2015, was admitted to the emergency room with acute urinary retention. Consecutively, a suprapubic catheter was inserted. Attempts of catheterization failed due to bulbar stenosis and an obstructive prostatic urethra. After the resolution by dilatation of the bulbar stenosis, post-voiding residual volume persisted at up to 150 ml. The intra- and postoperative course after TPR-P was uneventful. No adverse events occurred. The assessment after six weeks revealed an International Prostate Symptom Score (IPSS) improvement of nearly 50% for the symptoms and >60% for overall satisfaction (preoperative: IPSS: S=24, L=6; postoperative IPSS: S=13, L=2). The average post-voiding residual volume decreased from 150 ml preoperatively to 15 ml (range 0-30 ml) postoperatively. Due to the missing full length of the urethra, the augmented range of motion seemed almost too loose for classic resection techniques in our hands. Therefore, we believe that in such cases it might be advantageous to use enucleation techniques. However, in our case, TPR-P was feasible and safe with a good functional outcome.

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