Objective: To evaluate the outcomes and safety of the surgical technique transurethral anatomical enucleation of prostate (TUAEP) in patients with prostatic hyperplasia for whom surgery was indicated.

Materials and Methods: The authors conducted a retrospective pilot study and analyzed the medical records of 80 patients who underwent TUAEP by a single surgeon between December 2016 and January 2018 in the Minimally-Invasive Surgery (MIS)-Urology Department in Rajavithi Hospital. Only 40 cases had complete review data, and these were included in the present study. The authors analyzed International Prostate Symptom Score, quality of life score, peak flow rate, and post-void residual urine volume preoperatively, and then 1, 3 and 6 months postoperatively. The TUERP operative time, enucleated tissue weight, catheterization time, and post-operative complications were recorded.

Results: The participants’ mean age was 70.90+5.55 years. There were statistically significant differences between mean preoperative and postoperative hemoglobin (13.36+1.49 and 12.42+1.57), and hematocrit (%) (41.13+3.54 and 38.73+4.41), p<0.01. Mean blood transfusion was 0.10+0.37 units, mean prostatic specific antigen (PSA) decreased from 7.50 (0.90 to 35.50) postoperatively (p<0.001) to PSA 1.13+0.78 ng/ml at 3 months postoperatively (p<0.02) and to PSA 1.54+0.78 ng/ml at 6 months postoperatively (p<0.01). Maximum flow rate (Qmax), post void residual urine (PVR), international prostatic symptoms score (I-PSS) and quality
of life (QOL) score improved significantly immediately after surgery and continued to improve up to follow-up at 6 months (p = 0.01). At 6 months, mean Qmax had increased from 9.05 to 21.19 ml/sec (p<0.01) and mean PVR had decreased from 124.30 to 61 ml (p<0.03). Mean I-PSS improved from 17.82 to 1.54 (p<0.01) and mean QOL score improved from 3.97 to 0.92 (p<0.01). There were no serious complications or incidences of TURP syndrome in any patient in the present study.

Conclusion: TUAEP is a true anatomical enucleation and seems to be the best modern alternative to transurethral resection of the prostate and open prostatectomy for bladder outlet obstruction caused by benign prostatic hyperplasia. The long-term results in terms of efficacy and safety need to be validated in further prospective randomized controlled studies.

Keywords: Prostate, Prostatic hyperplasia, Transurethral enucleation of prostate, Transurethral anatomical, Transurethral resection of prostate, Surgical procedures, Minimally invasive, TUAEP, TUERP