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Introduction: New techniques have been proposed for the surgical treatment of benign prostatic hypertrophy (BPH): laser enucleation and laparoscopic adenomectomy. The objective of this retrospective study was the comparison of the results of Millin adenomectomy realized under contemporary medical conditions, with the results of laser enucleation and laparoscopic adenomectomy., Method: Two hundred and forty consecutive Millin adenomectomy cases performed between January 2004 and December 2008 were analyzed. Patient evaluation before operation consisted in IPSS score, quality of life score, maximum flow rate (Qmax), post-void residual volume (PRV), total prostate volume (TPV) performed under trans-rectal ultrasound. Operation duration, adenoma weight, blood loss during operation, transfusion rate, duration of Foley catheterization, duration of hospital stay, and immediate postoperative complications according to Clavien classification were reported. Each patient was systematically controlled at 3 months and was invited by mail for a second control in 2012. Each of the two outpatient controls consisted in the realization of an IPSS, quality of life score, Qmax and PRV. Our results were compared to contemporary results published concerning open adenomectomy and new techniques of adenomectomy., Results: Mean age was 69 years, TPV before operation 111 cc, adenomectomy specimen weight 82 gr, blood loss during operation 246 mL, transfusion rate 6 %, operation duration 88 min, Foley catheterization duration 3.8 days, mean hospital stay 5.6 days. Clinical results at 3 months were: IPSS decrease from 25 to 5 points, quality of life score decrease from 5 to 0.7 points, Qmax increase from 6.5 to 22 mL/sec, PRV decrease from 115 to 7.5 mL. According to the use of either the classical classification or of Clavien classification, the rate of early complications varied respectively from 36 to 49 %. No Clavien grade 4 or 5 complication was observed. Long-term results in 137 (57 %) of the patients with a mean age of 80 years, 5 years medial control (4; 8) after adenomectomy showed an IPSS varying from 2.5 to 6.6 points according to follow-up length, quality of life score varying from 0 to 1.2 points, Qmax varying from 13 to 23 mL/sec, PRV varying from 0 to 25 mL., Conclusion: The lack of exhaustivity of the results and the absence of use of Clavien classification rendered difficult any comparison between the different techniques. Urologist motivation in favor of a given technique represented a bias difficult to bypass, even with the realization of a randomized study comparing two techniques. Today, Millin operation still represented the gold standard for the evaluation of new techniques in the surgical treatment of large volume BPH., Level of Evidence: 5., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Introduction Laparoscopic adenomectomy for prostates larger than 80 mL is still a topic of debate. The purpose of this study is to evaluate the perioperative outcomes and complications between open Millin (OM) and laparoscopic Millin (LM) adenomectomy. Material and methods Perioperative data and complications were retrospectively collected from patients submitted to Millin procedure from August 2019 to August 2022 in a tertiary centre, and OM and LM were compared. Complications were classified according to Clavien-Dindo classification. Results A total of 205 patients were identified, 125 in the OM group and 80 in the LM group. Baseline characteristics were similar between the groups. Mean total blood loss (194 ±210 vs 477 ±389 mL, p <0.001), mean haemoglobin drop (1.40 ±1.16 vs 2.62 ±1.42 g/dL, p <0.001), duration of catheterisation (4.63 ±1.39 vs 5.37 ±1.99 days, p = 0.004), and hospital stay (4.59 ±1.72 vs 5.82 ±3.36 days, p = 0.003) were significantly lower in the laparoscopic group. The mean operative time was longer in the laparoscopic group (109.9 ±33.4 vs 68.7 ±18.0 min, p <0.001). The overall complication rate was significantly lower in the laparoscopic group (18.8% vs 36.8%; p = 0.012), and this difference was maintained only in Clavien-Dindo groups I (3.8% vs 13.6%; p = 0.018) and II (12.5% vs 21.6%; p = 0.049). Regarding individual complications, patients in the LM group had significantly less haematuria (1.3% vs 8.8%, p = 0.031), wound infections (0% vs 4.8%, p = 0.047), and blood transfusions (0% vs 6.4%, p = 0.024). Conclusions Laparoscopic Miilin adenometomy is a safe technique, with less intraoperative blood loss, shorter length of hospital stay and catheterisation time, and fewer complications, including a lower transfusion rate, than its open counterpart. [ABSTRACT FROM AUTHOR]

Abstract: Background: We performed more than 450 laproscopic retropubic prostatectomy procedures since 2001. Objective: To describe the Finger Assisted Laparoscopic Retropubic technique (FALRP) in the treatment of large adenoma. We present the results of the last 100 procedures using FALRP. Materials and methods: From January 2004 to October 2005, 100 patients with indication of prostatic adenomectomy were operated on FALRP. Preoperative, perioperative and post operative parameters were collected retrospectively. Complications and risk factors were also evaluated. Results: Mean age of the patients was 67.84 years (SD 7.62) and mean BMI was 25.47 (SD 1.66); mean follow-up was 14.05 months (SD 5.25); mean prostatic volume assessed by TRUS was 97.1ml (SD 18.46) and mean maximum flow Qmax was.6.03ml/sec (SD 2.37). Mean operative time was 66.34mn (SD 12.31); mean blood lost was 250ml (SD 86.82). No patient required transfusions or conversion to open surgery. Mean resected tissue weight was 68.2gr (SD 15.46) and mean catheterization time was 3.17 days (SD 1.01). Prolonged bladder catheterization was necessary for two patients with mandatory anticoagulation. The mean hospital stay was 4.3 days (SD 1.27). Post operative mean maximum flow Qmax was 26.35ml/sec (SD 5.87). We found 4 PIN high grade and no invasive prostate carcinoma. Conclusions: In the hands of an experienced laparoscopic team, FALRP for large benign prostatic hyperplasia is a feasible, reproducible alternative approach to open surgery. It is safe, with minimal intraoperative haemorrhage and post-operative complications, and a shorter convalescence period than open surgery. We believe that FALRP should be part of the armamentarium of any experienced laparoscopic urological surgeon. [Copyright &y& Elsevier]

Abstract: Objective: To demonstrate the safety of the Millin extraperitoneal laparoscopic adenomectomy by comparing the laparoscopic and open approaches. Methods: From January 2003 to April 2005, patients, with indication of prostatic adenomectomy, were offered the chance to choose between 2 types of procedure: Millin adenomectomy with open or extraperitoneal laparoscopic approach. Forty patients were included in this prospective non-randomised study. The patients were divided into 2 Groups. Group A (20 patients) underwent extraperitoneal laparoscopic adenomectomy, while Group B (20 patients) was treated by open surgery. Pre-operative, peri-operative and post-operative parameters were evaluated. Group A was subdivided in two sub-groups (first ten and last ten) and peri-operative parameters were considered in order to determine the learning curve. Results: In terms of pre-operative parameters considered, the 2 study groups are comparable (p >0.3). As far as peri and post-operative parameters are concerned: mean blood loss for Group A was 411.6±419ml, for Group B 687.5±298.6ml (p =0.004). For all the other parameters no significant statistical differences were recorded (p >0.4). Mean operative time was 107.2±34.9min in Group A, and 95.5±22.5min in Group B. Mean adenoma weight in Group A was: 69,5±21.5g, in Group B: 88.1±43.8g. Mean haemoglobin levels in Group A was: 11.2±1.8g/dl, Group B: 11.6±1.2 (10–13.4) g/dl. Mean Analgesic consuming (Tramadol) during the post-operative stay was 385±36mg in Group A, versus 430±108mg in Group B. Mean catheterization time was 6.3±3.7 days in Group A, 5.6±1.1 days in Group B. The mean hospital stay was 7.8±4.1 days in Group A, and 7±1.6 days in Group B. One patient (5%) from Group A was re-operated for bleeding and clot retention, whilst in Group B patients did not present complications which required any further intervention. As far as peri-operative and post-operative parameters of the two sub-Groups A (first ten patients and last ten patients) are concerned, the statistical evaluation shows a significant difference only on operative time (p =0.01). The p-value for the other parameters was not significant (p >0.1). Conclusions: The extraperitoneal laparoscopic adenomectomy is a safe technique presenting results comparable to open surgery with the advantage of significantly lower peri-operative blood loss. [Copyright &y& Elsevier]