Prostate Enucleation

• Those experiencing moderate to severe symptoms of enlarged prostate (BPH)
  • Weak stream of urine
  • Incomplete emptying of the bladder
  • Stop and start when urinating
  • Straining to begin urination
  • An increased need to urinate
  • Interrupted sleep because of the need to urinate
  • Complications of enlarged prostate
• Those who want an alternative option to TURP for management of their BPH
• Those who have enlarged prostate symptoms and have failed minimally-invasive treatment options
• Those whose prostate anatomy is not appropriate for other treatment options
• Those who have failed medical therapy, don’t want to take medication or have had side effects
• Those who want to improve their quality of life to what it was before BPH symptoms

Robotic enucleation of prostate is generally performed for patients with very large prostates (usually more than 150cc) in which case other procedures are not safe or possible:

• Very effective treatment option
• Durable improvement in urinary symptoms with low revision rates
• Quick recovery with minimal bleeding and recovery time after surgery
• Eliminates the need for lifelong use of medications

The minimally-invasive robotic approach offers both surgeons and patients various benefits when compared to traditional open surgery:

• Less blood loss
• Smaller incisions
• A shorter hospital stay
• Faster recovery time

Surgeon benefits include:

• High definition 3D vision inside the body
• Small instruments that allow a greater range of movements than the human hand
• Improved dexterity and vision that allows for very precise movements and enhanced control

This procedure replicates with a minimally invasive approach, the traditional open surgery (Millen’s or Freyer’s procedure) historically performed for patients with a very large prostate:

• The patient is placed under general anaesthetic for the duration of the procedure, which usually lasts between 2-4 hours
• Several small incisions are made in the abdomen, through which the surgeon inserts the surgical tools and camera
• The abdomen is filled with carbon dioxide gas, which creates space and allows the surgeon to view the organs clearly and access them accurately
• The surgeon controls the robotic tools to carefully remove only the part of the prostate which is enlarged (BPH) and causing symptoms of obstruction. The enlarged lobes of the prostate are ‘shelled out’ (enucleated) and then removed via a small incision in the bladder, creating an open prostatic urethra
• The bladder is then meticulously repaired using an absorbable suture
• The carbon dioxide is released and surgical instruments are removed
• Incisions are closed with a technique that minimizes the risk of hernia or scarring

• Patients generally remain in hospital for 2-3 nights following the procedure
• You will be able to walk around the day following surgery
• A urinary catheter will temporarily be in place. It is a thin tube that runs from the bladder through the penis, allowing urine to drain into a bag on the outside of the body. This allows healing of the bladder. This will need to remain for 5-7 days after the surgery.

• This procedure is not to be confused with ‘radical’ prostatectomy where the entire prostate is removed for treatment of prostate cancer. In Robotic enucleation of prostate the prostate capsule and surrounding nerves and urinary sphincter are not disrupted, significantly reducing the chance of erection problems and incontinence
  Most patients will notice an immediate improvement in their urinary flow, pressure and bladder emptying
• Bladder symptoms of urinary frequency, urgency and nocturia (getting up at night to pass urine) tend to take longer (up to 3 months) to improve
• The seminal vesicles are not removed but ‘retrograde ejaculation’ occurs in most cases; this is where semen fluid goes back into the bladder after orgasm. This is not dangerous or harmful.

Melbourne Urology Centre offers Robotic enucleation of prostate treatment in Melbourne to local and interstate patients. Your case will be thoroughly evaluated including a discussion of other appropriate management options. We offer a full range of surgical options for enlarged prostate (BPH), including:

• Rezum
• HOLEP (Holmium Laser Enucleation of Prostate)
• Green light prostate laser surgery
• TURP (Transurethral Prostate Resection)

Written by Dr. Shekib Shahbaz and Dr. Tony de Sousa

Thuroff, J. W., Leicht, W., Kamal, M. M., Hampel, C., (2012), Robotic-assisted laparoscopic enucleation of benign prostatic hyperplasia (BPH)110(9), [https://bjui-journals.onlinelibrary.wiley.com/doi/abs/10.1111/j.1464-410X.2012.11603.x], accessed 27/02/21.