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Introduction <p>Single-Port Transvesical Enucleation of the Prostate (STEP) is a minimally invasive robotic technique for managing benign prostatic hyperplasia (BPH), particularly in prostates ≧&#xa0;80 cc. However, its outcomes in very large prostates (&gt;150 cc) remain under-characterized. We compared perioperative and functional outcomes of STEP between large (LP: 80–150 cc) and very large prostates (VLP: &gt;150 cc).</p> Materials and methods <p>We retrospectively reviewed 183 patients who underwent STEP using the da Vinci Single-Port system (2019–2024). Patients were stratified into LP and VLP cohorts based on prostate volume (PV). Enucleation efficiency was defined as enucleated tissue weight divided by enucleation time (g/min). Outcomes were compared using descriptive statistics.</p> Results <p>A total of 179 patients were included (LP: 93; VLP: 86). Median PV was significantly greater in the VLP group (194 vs. 117 cc, <i>p</i> &lt; 0.001). VLP patients had higher PSA (9.7 vs. 6.75 ng/mL, <i>p</i> = 0.002), longer enucleation (84 vs. 69 min, <i>p</i> = 0.002) and console times (115 vs. 98 min, <i>p</i> = 0.010), and improved enucleation efficiency (1.23 vs. 0.97 g/min, <i>p</i> = 0.025). Estimated blood loss was slightly higher in VLP (100 vs. 80 mL, <i>p</i> = 0.026). All procedures were completed without conversion or additional ports. Hospital stay, catheter duration, and same-day discharge rates were comparable. At 3 months, both groups had equivalent improvements in International Prostate Symptom Score (3 vs. 3, <i>p</i> = 0.913), quality-of-life scores (0 vs. 1, <i>p</i> = 0.965), and maximum flow rate (17.5 vs. 16 mL/s, <i>p</i> = 0.594). Complications were rare, with no readmissions and only two major postoperative events. Urinary continence was preserved in all patients, with transient incontinence occurring in 6 patients (LP: 2; VLP: 4), resolving completely by 3 months.</p> Conclusions <p>STEP is effective and scalable for prostates ≥&#xa0;80 cc, demonstrating improved enucleation efficiency in very large glands without compromising safety, recovery, or continence preservation.</p>

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Single-port transvesical enucleation of the prostate (STEP) for benign prostatic hyperplasia: a comparative analysis of patients with large (80–150cc) and very large (>150cc) prostate volumes

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  • 发表日期：

    2026年2月21日

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  • Salim K. Younis,
  • Nicolas A. Soputro,
  • Adriana M. Pedraza,
  • Carter D. Mikesell,
  • Abdulrahman Al-Bayati,
  • Samarpit Rai,
  • Lin Wang,
  • Rui M. Bernardino,
  • Ruben Olivares,
  • Mohamed Eltemamy,
  • Zeyad R. Schwen,
  • Riccardo Autorino,
  • Jihad Kaouk

摘要

Introduction

Single-Port Transvesical Enucleation of the Prostate (STEP) is a minimally invasive robotic technique for managing benign prostatic hyperplasia (BPH), particularly in prostates ≧ 80 cc. However, its outcomes in very large prostates (>150 cc) remain under-characterized. We compared perioperative and functional outcomes of STEP between large (LP: 80–150 cc) and very large prostates (VLP: >150 cc).

Materials and methods

We retrospectively reviewed 183 patients who underwent STEP using the da Vinci Single-Port system (2019–2024). Patients were stratified into LP and VLP cohorts based on prostate volume (PV). Enucleation efficiency was defined as enucleated tissue weight divided by enucleation time (g/min). Outcomes were compared using descriptive statistics.

Results

A total of 179 patients were included (LP: 93; VLP: 86). Median PV was significantly greater in the VLP group (194 vs. 117 cc, p < 0.001). VLP patients had higher PSA (9.7 vs. 6.75 ng/mL, p = 0.002), longer enucleation (84 vs. 69 min, p = 0.002) and console times (115 vs. 98 min, p = 0.010), and improved enucleation efficiency (1.23 vs. 0.97 g/min, p = 0.025). Estimated blood loss was slightly higher in VLP (100 vs. 80 mL, p = 0.026). All procedures were completed without conversion or additional ports. Hospital stay, catheter duration, and same-day discharge rates were comparable. At 3 months, both groups had equivalent improvements in International Prostate Symptom Score (3 vs. 3, p = 0.913), quality-of-life scores (0 vs. 1, p = 0.965), and maximum flow rate (17.5 vs. 16 mL/s, p = 0.594). Complications were rare, with no readmissions and only two major postoperative events. Urinary continence was preserved in all patients, with transient incontinence occurring in 6 patients (LP: 2; VLP: 4), resolving completely by 3 months.

Conclusions

STEP is effective and scalable for prostates ≥ 80 cc, demonstrating improved enucleation efficiency in very large glands without compromising safety, recovery, or continence preservation.