The suprapubic approach to minimally invasive surgery for benign prostatic hyperplasia (BPH) remains a relatively unexplored area. In this context, STAR-P (Suprapubic Transvesical Adenoma Resection of the Prostate), whose technique was recently described and published, represents a completely original innovation. We present updated functional data from our case series.

This single-center single-operator study involved a retrospective analysis of prospectively collected data from 80 consecutive patients who underwent the STAR-P procedure. Data were gathered in a dedicated database and analyzed using descriptive statistical methods. The procedure involved a dedicated 42 Fr bipolar resectoscope designed specifically for suprapubic prostate resection. The suprapubic approach offers substantial freedom of movement, and the large caliber of the instrument allows for the resection of a significant tissue volume within a relatively short time frame. A urinary catheter is placed at the end of the procedure.

No intraoperative complications occurred. No patients developed complications related to the suprapubic access; on the contrary, all potential complications associated with the transurethral approach were avoided. The median operative time was 100 minutes, with a median resection time of 60 minutes. All patients experienced a significant improvement in their flowmetric indices, with a high level of satisfaction. The median preoperative maximum flow rate (Qmax) was 10.85 ml/s, while the postoperative Qmax was 22.5 ml/s. The postoperative post-void residual volume recorded a median of 0 ml, with a mean of 4.34 ml. The median postoperative IPSS score was 3.0. This study examined patients with a median prostate volume of 85 ml (ranging from 20 ml to 160 ml). Three out of 80 patients (3.75%) experienced symptoms of urinary urgency, which resolved within 60 days.

STAR-P is confirmed as a valid and safe technique for the surgical treatment of BPH and should be discussed with patients as one of the currently available options. The dedicated instrumentation allows for the treatment of larger prostate volumes while maintaining reasonable costs.