Anterior fibromuscular stroma-preserved endoscopic enucleation of the prostate: a precision anatomical approach

Background: Benign prostate obstruction (BOO) is becoming increasingly important in this aging society. Some urge/stress urinary incontinence (UUI/SUI) still occurs after endoscopic enucleation of the prostate (EEP). It remains unclear how post-EEP incontinence can be avoided. Currently, early apical release to ameliorate the traction of the external sphincter is the best technique for incontinence prevention. Objective: To describe our surgical technique of anterior fibromuscular stroma (AFS)-preserved EEP for BOO. Design, setting, and participants: The medical records of 60 consecutive patients who underwent AFS-preserved EEP for BOO in our center from September 2019 to December 2019 were retrospectively reviewed. Surgical procedure: AFS-preserved EEP starts at the 12 o’clock position of the urethra, and the junction between the AFS and transitional zone (T-zone) was identified. The AFS and T-zone were separated first to protect the AFS in the initial operative procedure. Then, following the usual enucleation procedure, AFS-preserved EEP could be achieved. Measurements: Postoperative prostate-specific antigen (PSA), testosterone, urethral stricture, and voiding status, such as incontinence, uroflow, and postvoiding residual urine were assessed. Results and limitations: The data show that AFS-preserved EEP could achieve similar surgical outcomes as other early apical release approaches. Conclusions: The preserved AFS provides a nice landmark at the 12 o’clock position during EEP.