Essential Anatomy for Benign Prostatic Hyperplasia Surgery

Abstract

  This review explores the critical anatomical insights essential for optimizing functional outcomes in surgical management of benign prostatic hyperplasia (BPH). With the introduction of minimally invasive surgical therapies (MIST), such as Prostatic Urethral Lift (PUL) and WAVE (Water Vapor Energy Treatment), as well as Urethral-sparing Robot-assisted Simple Prostatectomy (usRASP), significant advances have been achieved in preserving urinary continence and ejaculatory function. These techniques highlight the precise anatomical regions that govern these functions, underscoring their importance in contemporary practice.

  Holmium Laser Enucleation of the Prostate (HoLEP), while widely accepted, has traditionally been associated with postoperative stress urinary incontinence (SUI). Yet, innovations like the Omega Sign technique and early apical releasing have allowed for greater protection of the external urethral sphincter, markedly reducing the risk of SUI.

  In terms of preserving ejaculatory function, the integrity of tissues surrounding the verumontanum remains vital. Techniques such as TURP and Photoselective Vaporization of the Prostate (PVP) have demonstrated high ejaculatory preservation rates, whereas HoLEP faces inherent limitations in sparing urethral tissue. Aquablation, using the “butterfly cut” approach, shows promising reproducibility in ejaculatory preservation.

  Integrating advanced anatomical understanding with these surgical innovations holds the potential to enhance patient quality of life, refining functional outcomes and supporting a nuanced, patient-centered approach to BPH management.