Closed prostatic commissurotomy. An endoscopic technique for the treatment of benign prostatic hypertrophy.

Closed prostatic commissurotomy was performed in 27 patients with benign prostatic hypertrophy. The procedure was done under local anaesthesia. Through a 1-cm suprapubic incision, the retropubic space was insufflated with carbon dioxide or nitrous oxide and the endotherm introduced. The laparoscope was also introduced into the retropubic space through a second puncture. The prostatic commissure was identified, coagulated and divided, sparing the mucosa of the prostatic urethra. Commissurotomy causes urethral decompression, which is the aim of any treatment for benign prostatic hypertrophy. The result was satisfactory in 85% of patients. Failures were due to incomplete commissurotomy; laparoscopic revision led to good results. Urethral stricture, incontinence or epididymitis did not occur. Ejaculation was normal. The technique is simple and easy and the patient can leave the hospital on the same day.