The STAR-P technique is a surgical method developed by Prof. Christian Gozzi and recently published. Over the years, the technique has been refined, and its steps have been codified. We present a step-by-step description of the technique currently employed at our center.

The patient is positioned supine. The drape used for the operative field is equipped with lateral bags for fluid collection. A Dufour silicone catheter of 16 Fr or 18 Fr is placed. The bladder is filled with saline solution, positioning the bags approximately 60 cm above the neutral level. A transverse skin incision of 2-4 cm is made at the suprapubic level, and dissection proceeds through the layers until reaching the fascia, which is incised longitudinally. The bladder is accessed using two suture points, and an opening is created with an electrocautery. Once access to the bladder lumen is achieved, a 15 mm trocar is introduced, through which a dedicated 42 Fr bipolar resectoscope is inserted. The ureteral orifices are identified and marked with distal coagulation. A circular delineation is performed using coagulation to outline the prostate. The balloon of the catheter is deflated, and under direct visualization, the tip of the catheter is retracted to the verumontanum. The bladder catheter will serve as outflow, while inflow will come from the resectoscope. In the initial phase of the procedure, a medium or large loop is utilized. If present, resection begins from the third lobe. Subsequently, resection is performed from the 12 o'clock position down to the base, completing the resection of each lateral lobe. A small or medium loop is then used to refine the anterior wall and the apex. At the end of the procedure, chips are evacuated using an Ellik evacuator or individually with the resectoscope. Careful hemostasis of the prostatic fossa is conducted. A Dufour catheter of 16 Fr or 18 Fr is cuffed under direct visualization in the bladder lumen. Closure of the layers is performed in multiple layers.

Functional outcomes have proven to be comparable to those of the main surgical techniques used for the treatment of benign prostatic hyperplasia (BPH). Patient satisfaction levels have also shown to be similarly aligned. The technique has proven effective even for large prostatic adenomas.

STAR-P is a well-codified procedure, with steps that can be tailored based on the surgeon's experience and the morphology of the prostate. Overall, it is a safe, effective, and reproducible technique.