Oh Seung-June, Shitara Toshiya
Department of Urology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.
Department of Urology, Fuchinobe General Hospital, Sagamihara, Kanagawa, Japan.
Andrologia. 2020 Sep;52(8):e13744. doi: 10.1111/and.13744. Epub 2020 Jul 9.
Among transurethral surgery for benign prostatic hyperplasia (BPH), anatomical endoscopic enucleation of the prostate (AEEP) differs from conventional transurethral surgery as it adopts the same enucleation principle as open surgery. AEEP is known as an effective and safe surgical method. However, the learning curve is steep because the surgical anatomy is different from that of conventional transurethral surgery. If information on surgical anatomy related to enucleation is enriched and surgical standardisation is achieved, the learning curve will be shortened and AEEP will become more widespread. The concept of AEEP has been developed based on the surgical techniques obtained from holmium laser enucleation of prostate (HoLEP). The original surgical technique of HoLEP is a three-lobe technique. At the 12 o'clock position at the prostatic apex, the boundary of the prostate capsule is unclear. Separating anterior prostatic tissue from the prostatic capsule while preserving the sphincter in the apical area is one of the biggest challenges in AEEP. During the AEEP procedure, an accurate understanding of the surgical anatomy of the capsular plane, bladder neck, apical sphincteric area and blood vessels is important. In this article, literature on the anatomy related to enucleation in AEEP, mainly HoLEP, is reviewed and discussed.
在良性前列腺增生（BPH）的经尿道手术中，解剖性前列腺内镜剜除术（AEEP）与传统经尿道手术不同，因为它采用了与开放手术相同的剜除原则。AEEP是一种有效且安全的手术方法。然而，由于手术解剖结构与传统经尿道手术不同，其学习曲线较陡。如果丰富与剜除相关的手术解剖信息并实现手术标准化，学习曲线将缩短，AEEP也将得到更广泛的应用。AEEP的概念是基于前列腺钬激光剜除术（HoLEP）的手术技术发展而来的。HoLEP最初的手术技术是三叶技术。在前列腺尖部的12点位置，前列腺包膜边界不清晰。在AEEP中，最大的挑战之一是在保留尖部区域括约肌的同时，将前列腺前组织与前列腺包膜分离。在AEEP手术过程中，准确了解包膜平面、膀胱颈、尖部括约肌区域和血管的手术解剖结构非常重要。本文对主要与HoLEP相关的AEEP中剜除术的解剖学文献进行了综述和讨论。
