Feasibility of Suprapubic Transvesical Endoscopic Prostatectomy
Phase: NA
Conditions: Prostate
Sponsor: Beni-Suef University

 
 
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Feasibility of Suprapubic Transvesical endoscopic 
prostatectomy 
Protocol for a thesis submitted for partial fulfillment of M.D.  degree in urology 
BY 
Moustafa Hosny Mohamed  
Assistant Lecturer of urology, Beni-Suef University 
Supervised by: 
Dr/ Ahmed Mahmoud Hasan Abd el Bary  
Professor of urology Beni-Suef university 
 
Dr/ Rabiee Mohamed Abdallah 
Associate Professor of urology Beni-Suef university 
 
Dr/ Amr Mohamed Lotfy 
Associate Professor of urology Beni-Suef university  
Dr/ Ahmed Gamal Mohamed  
Lecturer of urology Beni-Suef university  
Faculty of Medicine 
Beni–Suef University 
2025 
 
 
 

 
 
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❖ Introduction: 
Lower urinary tract symptoms (LUTS) are highly prevalent in men older than 
50 years and represent a large epidemiological and financial burden [1].  Benign 
prostatic obstruction (BPO) is one of the most common causes of LUTS in middle-
aged and older men. Benign prostatic hyperplasia (BPH) is a histological diagnosis 
that increases in prevalence with age, and autopsy studies have shown that 80–90% 
of men will have evidence of BPH in their 70s or 80s. However, not all of these men 
will develop LUTS with symptoms typically arising when the prostatic enlargement 
results in obstruction [2].  
 Epidemiological data suggest a lifetime prevalence of LUTS suggestive of 
BPO of 26.2% and this increases with age [3]. With a globally aging population, the 
incidence of BPO is continuing to increase and it's treatment estimated $73.8 billion 
annual cost burden [4].  
LUTS also have substantial impact on the quality of life (QoL) of patients, 
with one study reporting that severe LUTS produce a similar impact on QoL to a 
heart attack or stroke. BPO mostly is a progressive condition and factors associated 
with clinical progression include increased age, increased prostate volume, elevated 
PSA and low peak urinary flow rate (Qmax) [2]. Fortunately, numerous treatment 
options are available to manage LUTS secondary to BPO including both medical 
and surgical [5].  
In men with LUTs alpha1 adrenoreceptor antagonists can be offered as first 
line medical therapy [6]. Over time, various surgical techniques have emerged for 
BPO treatment, each with distinct strengths and weaknesses. The transition from 
open simple prostatectomy to monopolar or bipolar transurethral resection of the 
prostate (M/B-TURP) marked a pivotal moment, enhancing safety and reducing 

 
 
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invasiveness, maintaining its gold standard status for prostatic volumes from 30 to 
80 cm3 [7,8]. Techniques such as thulium or holmium laser enucleation of the 
prostate (HoLEP) and robot-assisted simple prostatectomy (RASP) are widely used 
[9,10].   
Prostatic uretheral lift (UroLift), convective water vapor energy (Rezum) and 
prostatic arterial embolization can be performed with local anesthesia . Although the 
literature currently suggest that minimally invasive procedures are associated with 
higher rates of clinical failure requiring secondary interventions [6]. 
Despite significant improvements in surgical techniques, the incidence of late 
complications such as urethral stricture after TURP has not decreased. Reports of 
urethral stricture rates vary widely, ranging from 1% to as high as 10–12%, 
depending on the surgical technique and the series analyzed [11,12].  
 Mechanical stress exerted on the external urinary sphincter during 
transurethral procedures can result in transient urinary incontinence (UI) which may 
adversely affect patient QoL [13]. The treatment of choice for patients with past 
history of previous surgery for uretheral stricture who present with of obstruction 
due to BPH is still a matter of discussion [14].  
The debate is about whether the feasible insertion of the resectoscope in 
previously operated urethera carries a high risk of multiple microtrauma that in turn 
can lead to scar formation and repeat stricture development [15].  
In patients who had previously undergone dorsal onlay urethroplasty for 
urethral strictures The need to protect the delicate urethral graft in these patients 
justified a suprapubic approach [13].  
In patients with penile prosthesis, any transurethral procedure could place the 
implant at risk. The use of long or extra-long resectoscope can be of some assistance; 

 
 
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however, these are not available in many institutions [14]. So suprapubic transvesical 
endoscopic prostatectomy is newly developed to bypass the anterior urethra.  
❖ Aim of the work: 
To determine safety and efficacy of Suprapubic Transvesical endoscopic 
prostatectomy.  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
 
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❖ Patients and methods: 
This prospective clinical study will be conducted at the department of urology, Beni 
suef university Hospital on selected 60 Men indicated for surgical treatment of 
benign prostatic hyperplasia fulfilling the inclusion criteria. The study will be 
conducted for 6 months starting from July 2025 (The date of ethical committee 
approval). 
 Inclusion criteria  
Male patients with moderate to severe lower urinary tract symptoms ( IPSS score ≥ 
8 ) indicated for surgical intervention with prostate size less than 120 cc.  
Exclusion criteria 
History of previous pelvic surgery, urothelial cancer, kidney transplantation, 
uncontrolled coagulopathy, and significant central fat accumulation that could 
potentially increase the risk during transvesical access(body mass index not 
exceeding 27 kg/m2)  
 
Preoperative Assessment  
All patients will undergo a thorough preoperative evaluation, including: 
• 
History mainly IPSS score and Physical Examination 
• 
Laboratory Tests: 
          Complete blood count , Kidney function tests (serum creatinine, serum 
electrolytes , Liver function tests, Coagulation profile , Prostatic specific antigen 
(PSA), Urine analysis & urine culture 
 

 
 
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• 
Imaging:  
         * Pelvi–abdominal ultrasonograghy to assess post voiding residual urine 
(PVR). 
         * Trans rectal ultrasound (TRUS) for accurate estimation of the prostate size.  
* Preoperative Uroflowmetry.  
* A preoperative urodynamic study (UDS) was performed in patients with a 
chronic indwelling catheter , patients with post voiding residual urine more 
than 150 cc and in those clinically suspected of neurological problems 
Surgical Technique  
Cysto-uretheroscopy will be done to evaluate the  urethera , detect any bladder 
pathology and to visualise steps of insertion of laparoscopic port. The patient 
will be in  supine position, and the surgeon will stand beside the patient .The 
bladder is filled with normal saline until it is completely full . Using Ultrasound 
A 18 G puncture   needle is inserted 4 cm above the upper margin of the  
symphysis pubis to gain access to the bladder. then track is formed through 
single step dilation using a 30 Fr amplatz dilator and 10 mm laparoscopic port 
over it. Before starting the procedure, the ureteral orifices must be identified.  
 
Sample size calculations: 
The sample size calculation was performed using G*Power 3.1.9.7 for a paired 
samples t-test (difference between two dependent means). A priori power analysis 
was conducted to determine the required sample size. Based on the previous study 
(Bucca et al., 2024) [13], IPSS score showed mean difference of 26.5 which is 
considered an effect size (dz). Given an alpha error probability of 0.05 and a desired 
power of 0.95, the analysis revealed that a total sample size of 4 participants is 
needed to achieve the specified power level. The actual power achieved with this 

 
 
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sample size was 0.95, slightly exceeding the target. Additionally, the previous study 
[13] did not show a sample size calculation and just recruited a total of 44 patients. 
Hence, a sample size of 80 patients is suggested for this study, considering about the 
double of the previous study sample size. 
 
Statistical analysis 
The collected data will be revised for accuracy and completeness then coded, 
entered, and analysed using Statistical package for Social Science (SPSS version 25) 
program. Suitable analysis will be done  
Descriptive statistics:  
o Qualitative data will be presented in the form of numbers and percentages 
(proportions).  
o Quantitative data will be presented in the form of mean and standard deviation 
(mean ± SD). 
Analytical statistics: 
Differences will be considered significant at p-value less than or equal to 0.05. 
Analysis of relations will be done using the appropriate statistical tests according to 
the type of data obtained for each parameter.  
Ethical considerations: 
Patients will be informed that  procedure is an innovative procedure in its 
standardization phase and written consent for treatment and data publication Will be  
obtained . 

 
 
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Ethical approval will be obtained from the Research Ethical Committee (REC) in 
the Faculty of Medicine – Beni Suef University, Beni Suef, Egypt. 
 
 
 
 
References: 
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Chughtai, B. (2023). Minimally invasive treatments for benign prostatic 
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2) Hughes, T., Harper, P., & Somani, B. K. (2023). Treatment algorithm for 
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3) Lee, S. W. H., Chan, E. M. C., & Lai, Y. K. (2017). The global burden of lower 
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Tikkinen, K. A. (2021). A systematic review of patients’ values, preferences, and 

 
 
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