1. JOURNAL OF ENDOUROLOGY
Volume 25, Number 3, March 2011
ª Mary Ann Liebert, Inc.
Pp. 459–464
DOI: 10.1089=end.2010.0453
Novel Surgical Technique for Obstructive
Benign Prostatic Hyperplasia: Finger-Assisted,
Single-Port Transvesical Enucleation of the Prostate
Jong Jin Oh, M.D., and Dong Soo Park, M.D., Ph.D.
Abstract
Purpose: To report our experience with finger-assisted, single-port transvesical enucleation of the prostate (F-
STEP) compared with transurethral resection of the prostate (TURP) for benign prostatic hyperplasia.
Patients and Methods: From January 2009 to April 2010, perioperative data on the 32 patients in the F-STEP
group were collected and compared with the 67 patients in the TURP group. Intravesical prostatic protrusion
(IPP) grade 3 was included in the F-STEP group. In the F-STEP group, a homemade, single-port device using an
Alexis wound retractor was introduced transvesically through a small incision. After establishing a pneumo-
vesicum, the adenoma was enucleated laparoscopically with finger dissection. A conventional method was
performed in the TURP group.
Results: There was no significant preoperative difference in age, prostate size, maximum uroflow rate (Qmax),
dysuria, international prostate symptom score (IPSS), and quality of life score (QoLs) between the two groups.
The postoperative IPSS (4.00 vs 8.77, P ¼ 0.03), Qmax (36.19 vs 22.03 mL=min, P ¼ 0.04), dysuria (visual analogue
score 1.73 vs 3.14, P ¼ 0.04), and IPSS recovery period (5.54 vs 10.88 weeks, P ¼ 0.01) were significantly improved
in the F-STEP group compared with the TURP group. The mean operative time (109.42 vs 68.03 min, P ¼ 0.02)
and catheterization time (5.31 vs 2.09 days, P ¼ 0.03) were significantly longer. Weight of the extracted specimen
(48.35 vs 29.85 gm, P ¼ 0.03) were greater in the F-STEP than in the TURP group. In the F-STEP group, no
urethral stricture developed.
Conclusions: F-STEP is an effective technique modification without urethral complications that is indicated for
moderate-to-large prostates with intraveiscal protruding adenoma.
Introduction Recently, there has been increased interest in minimally
invasive techniques, such as single-port transvesical enucle-
ation of the prostate (STEP) for obstructive BPH.8 The initial
B enign prostatic hyperplasia (BPH) is one of the most
common diseases affecting the aging male. About 60% of
men over 60 years are affected.1,2 Currently, transurethral
reports of STEP were encouraging, but the indication for STEP
is large prostates (>90 cm3). Because a moderate-sized pros-
resection of the prostate (TURP) is recognized as the gold tate with a protruding adenoma is at risk of prostatic tissue
standard method of treatment for men with BPH. Never- regrowth because of difficulty in completely resecting the
theless, the incidence of complications (bleeding, urethral adenoma,9 we have included moderate-sized prostates with
stricture, and adenoma recurrence) is significant, despite im- protruding adenomas as an indication for STEP. In an attempt
provements in surgical technique. A larger caliber resecto- to prevent urethral strictures after the STEP procedure, we
scope for transurethral surgery will inevitably cause ischemia report our experience with finger-assisted, single-port trans-
and result in urethral strictures.3 Indeed, in most Asian pa- vesical enucleation of the prostate (F-STEP) as a modification
tients who have a narrow urethra, there is a greater chance of of STEP.
urethral strictures.4 Open simple prostatectomy remains the
procedure of choice for prostate adenomas too large for safe Materials and Methods
endoscopic resection.5,6 This procedure, however, is associ-
Study population
ated with considerable morbidity, including blood transfu-
sion, prolonged convalescence and catheterization, and even After obtaining Institutional Review Board approval, all
mortality.7 patients were included in this study between January 2009
Department of Urology, CHA Bundang Medical Center, CHA University, Seongnam-si, Korea.
459

2. 460 OH AND PARK
and April 2010. Ninety-nine patients received a diagnosis of
lower urinary tract symptoms secondary to BPH and had
responded poorly to medical treatment. A digital rectal ex-
amination was performed, and the serum prostate-specific
antigen (PSA) level was determined. A prostate biopsy was
performed if prostate cancer was suspected. The results were
evaluated using the following parameters preoperatively and
postoperatively (1 and 3 months): International Prostate
Symptom Score (IPSS), maximum uroflow rate (Qmax),
prostate volume, postvoid residual (PVR) urine volume,
quality-of-life score (QoLs), visual analogue scale (VAS) of
dysuria, and PSA level, analyzed by Student t test. The in-
clusion criterion for the patients was urinary symptoms of
moderate-to-severe intensity, as indicated by a Qmax 15
mL=s and an IPSS !10. Urodynamic studies, including pres-
sure-flow studies, were only performed in cases in which a
neurogenic bladder was suspected. Informed consent was
obtained from all patients.
Patients were assigned to one of the following two groups:
Group 1 (n ¼ 32) underwent F-STEP and group 2 (n ¼ 67)
underwent standard TURP. Assignment to the F-STEP group
was based on an intravesical prostatic protrusion (IPP) grade
3, regardless of the total prostate size. The methodology of IPP
measurement and its classification (three grades) was de-
scribed previously.10 Measurement of IPP was from the tip of
the protruding prostate to the base of the bladder. Grade 1 IPP
is intravesical protrusion 5 mm, grade 2 is >5 to 10 mm, and
grade 3 is >10 mm on transrectal ultrasonography (Fig. 1). FIG. 1. The measurement of intravesical prostatic protru-
sion (IPP). Transrectal ultrasonographic sagittal view of
Postoperative urethral stricture was diagnosed by
bladder and prostate: Measurement of IPP from the tip of the
cystourethroscopy Æ retrograde urethrography after present- protruding prostate to the base of the bladder. IPP grade 1,
ing symptoms recurrence. The SPSS software package version 5 mm or less; grade 2, more than 5 to 10 mm; grade 3, more
15.0 (Statistical Package for Social Sciences,TM Chicago, IL) than 10 mm. D ¼ distance of IPP.
was used for statistical analysis.
Surgical technique performed to reach the capsular plane (Fig. 2B). After suffi-
cient dissection under direct vision, the surgical glove was
F-STEP. Thirty-one patients were administered general
detached, and an index finger was introduced through the
anesthesia and 1 patient received spinal anesthesia. The pa-
Alexis wound retractor. The index finger was inserted into the
tients were in the supine position with mild flexion at the hip
dissection plane, the tip of the finger was forced around using
level. After the bladder was filled with physiologic saline, a
the fingernail as a wedge, and the prostatic adenoma was
2.5 cm low-vertical skin incision was made at the level of the
completely enucleated and extracted through the Alexis
bladder, 3 to 4 fingerbreadths above the symphysis pubis. The
wound retractor. Concomitant with finger dissection, a re-
anterior rectus sheath and rectus muscle were divided and
traction suture to the adenoma facilitated the enucleation
mobilized laterally. The bladder wall was identified and en-
(Fig. 2C).
tered with a small vertical incision.
Figure-of-eight sutures (2-0 polyglactin) were placed at the
An extra-small AlexisÒ wound retractor (Applied Medical,
4- and 8-o’clock positions, avoiding the ureteral orifices. He-
Rancho Santa Margarita, CA) and a surgical glove were
mostasis was confirmed under laparoscopic camera vision
fashioned and used as a homemade, single-port device11,12
without a pneumovesicum, an 18F three-way Foley catheter
(Fig. 2A). Specifically, the Alexis wound retractor was in-
was inserted via the urethra, and the balloon was inflated to
serted in the incised bladder, and over the outer ring of the
35 cc. Continuous irrigation was maintained until near clear
wound retractor, a size 6 1=2 surgical glove was attached.
urine color was emitted.
Three or four fingers of the glove were cut, and one 10-mm
TURP. A 24F continuous flow resectoscope (Karl Storz,
trocar and two or three 5-mm trocars were placed. A home-
Tuttlingen, Germany) with a 30 degree lens was used.
made, single-port device was constructed by securing the
UrosolÒ (CJ, Seoul, Korea) was used as an irrigation fluid
fingers of the glove to the end of the three trocars with a
throughout the procedure. All procedures followed the con-
rubber band and fixed to the outer ring of the wound retrac-
ventional method.
tor, followed by insufflation of the bladder with CO2 to 12 to
14 mm Hg to establish a pneumovesicum.
Results
Using articulating laparoscopic instruments (AutonomyÔ
Laparo-Angle,Ô Cambridge Endo, Framingham, MA), a cir- There was no significant difference in patient age, preop-
cular incision was made over the bladder mucosa around the erative prostate size, Qmax, PVR, dysuria (VAS) score, IPSS,
adenoma. Careful blunt and electrocautery dissection were or QoLs between the two groups (Table 1). The median

3. SINGLE-PORT TRANSVESICAL ENUCLEATION OF THE PROSTATE 461
FIG. 2. Surgical technique of F-STEP. (A) Homemade single-port device used in pneumovesicum. (B) Adenoma was
enucleated under direct vision using a hook electrode, drawing opposite direction with grasper. (C) Finger dissection
throughout the Alexis wound retractor. Retraction sutures from the adenoma facilitated the enucleation. F-STEP ¼ finger-
assisted, single-port transvesical enucleation of the prostate.
follow-up period was 10 months(range 3–14 mos). The mean 76.7% in the F-STEP group, both of which were significantly
size and range of transrectal ultrasonography (TRUS) were higher in the F-STEP group than in the TURP group (specimen
larger in the F-STEP group than in the TURP group. All of the weight, 29.85 g; P ¼ 0.03; specimen-to-TRUS size: 48.87%;
F-STEP group were included in grade 3 IPP. Table 2 details the P ¼ 0.02).
perioperative data. Significant improvement was observed in both groups in
The catheterization time (5.31 vs 2.09 days, P ¼ 0.03) and terms of Qmax, dysuria VAS score, and IPSS values. A sig-
operative time (109.42 vs 68.03 min, P ¼ 0.02) were signifi- nificant statistical difference in subjective (IPSS, QoLs, and
cantly increased in the F-STEP group compared with the dysuria VAS score) and objective (Qmax) postoperative out-
TURP group. In the F-STEP group, the urethral catheter re- comes was observed between the F-STEP and TURP groups
mained approximately 4 to 8 days (average 5.31 d) in most (Table 1). QoLs was improved, but not significant. Post-
patients who underwent the transvesical approach. In the F- operative mean IPSS, QoLs, and dysuria VAS score in the
STEP group, the average operative time was 109.42 Æ 44.48 F-STEP group (4.00, 1.08, and 1.73, respectively) were signif-
minutes (range 70–235 min), longer than in the TURP group, icantly lower than in the TURP group. In this study, we divided
68.03 Æ 25.02 minutes (range 30–120 min) for more technical the IPSS into two categories (storage symptom score [number
complexity and difficulty. 2, 4, and 7] and voiding symptom score [number 1, 3, 5, and 6]).
Estimated blood loss was 176.54 mL and 126.54 mL for While improvement was observed in both groups in terms of
F-STEP and TURP groups, respectively, without statistical the two symptom categories, a significant statistical difference
difference. Blood transfusions were necessary in two (6.3%) in the storage symptom category outcomes was observed be-
patients—only for the F-STEP not the TURP group. There tween the F-STEP and TURP groups in favor of the F-STEP
were no intraoperative or postoperative complications. Post- postoperatively (P ¼ 0.03). In the F-STEP group, storage
operative urethral stricture occurred in one paient in the symptoms were controlled. The overall symptom recovery
TURP group, diagnosed at 11 months after surgery. No ure- period was significantly shorter in the F-STEP group than in the
thral complication developed for the others of the TURP and TURP group (5.54 vs 10.88 weeks, P ¼ 0.01). There were no
all of the F-STEP group. surgical complications, persistent bleeding, anesthetic compli-
The mean weight of the enucleated tissue was 48.35 g, and cations, or CO2 emboli. The transurethral resection syndrome
the average ratio of extracted specimen-to-TRUS size was did not occur in any patient in the TURP group.

4. 462 OH AND PARK
Table 1. Comparison of Preoperative Parameters Discussion
and Postoperative Parameters in Finger-Assisted,
Single-Port Transvesical Enucleation of the Prostate TURP is the most commonly performed procedure in the
and Transurethral Resection of the Prostate Groups surgical management of BPH, with a focus on the physical
F-STEP TURP removal of hyperplastic growth.13 Because treatment and
(N ¼ 32) (N ¼ 67) P value early recurrence of symptoms are associated with residual
tissue, the optimal goal of therapy is the complete removal of
Age, years 70.19 Æ 6.78 69.17 Æ 7.97 0.23 hyperplastic tissue. A TURP can achieve near-complete re-
PSA level, ng=ml 3.88 Æ 1.84 4.89 Æ 1.64 0.33 section of the adenoma; a TURP is typically performed on
Prostate volume, ml 73.04 Æ 20.40 61.08 Æ 21.36 0.08 prostate glands 75 g. A TURP has increased operative
(Range) (48.29–102.60) (27.13–73.13) morbidity in procedures lasting >90 minutes and in elderly
Qmax, mL=s patients.14,15 For larger glands, suprapubic prostatectomy has
Preoperative 5.84 Æ 1.57 7.82 Æ 4.48 0.36 been used as an alternative to TURP1,7; however, the disad-
Postoperative 36.19 Æ 6.62 22.03 Æ 12.03 0.04 vantage is a larger incision, severe pain, and greater inva-
PVR, mL 66.27 Æ 24.99 89.79 Æ 101.99 0.07 siveness.
Dysuria (VAS score) Recently, a novel method, single-port transvesical simple
Preoperative 4.69 Æ 1.85 4.85 Æ 1.71 0.29 prostatectomy using a pneumovesicum and standard or
Postoperative 1.73 Æ 2.03 3.14 Æ 1.32 0.04 articulating laparoscopic instrumentation, has been intro-
IPSS duced. 8,16 The F-STEP has the benefits of laparoscopic mini-
Preoperative 27.12 Æ 7.27 27.27 Æ 7.01 0.90 mal invasiveness and effective removal using an open
Postoperative 4.00 Æ 1.13 8.77 Æ 3.15 0.03
surgical technique. In our study, the postoperative subjective
Storage Sx score symptoms in the F-STEP group were much improved com-
Preoperative 10.35 Æ 3.37 11.67 Æ 3.24 0.25
pared with the TURP group. Unlike the STEP study,8 the
Postoperative 1.27 Æ 0.60 4.33 Æ 1.48 0.03
F-STEP method was very effective, not only with large- but
Voiding Sx score
also moderate-sized prostates. In particular, intravesical, pro-
Preoperative 16.77 Æ 4.65 15.60 Æ 4.29 0.16
Postoperative 2.73 Æ 0.87 4.44 Æ 2.53 0.07 truding adenomas were highly indicated for surgical conve-
nience. Other objective outcomes were significantly improved
QoLs
Preoperative 4.73 Æ 0.72 5.02 Æ 0.49 0.26 in the F-STEP group compared with the TURP group.
Postoperative 1.08 Æ 0.39 2.40 Æ 1.43 0.11 Minimally invasive and effective procedures, such as hol-
IPP grade mium laser enucleation of the prostate and potassium-titanyl-
1 0 13 (19.4%) phosphate laser prostatectomy17,18 are effective, but bring a
2 0 54 (80.6%) concern about urethral strictures. Significantly late compli-
3 32 (100%) cations involving urethral strictures have been reported to
occur in approximately 15% of patients who undergo TURP
F-STEP ¼ finger-assisted single-port enucleation of the prostate; and other transurethral surgeries.4,14,19–21 A significant num-
TURP ¼ transurethral resection of the prostate; PSA ¼ prostate-
specific antigen; Qmax ¼ maximum uroflow rate; PVR ¼ postvoid
ber of such patients need a second intervention within 10
residual; VAS ¼ visual analogue scale; IPSS ¼ International Prostate years. In the F-STEP method, urethral instrumentation is
Symptom Score; Sx ¼ symptom; QoLs ¼ quality-of-life score; IPP ¼ minimal (only for urethral Foley catheterization); thereby,
intravesical prostatic protrusion. there is little risk of a urethral stricture. Although there was a
limitation of a short follow-up period, no urethral stricture
developed in this study. Also, the sphincter could be pre-
served under direct laparoscopic vision for more accurate
dissection. No incontinence was observed in this study,
Table 2. Operative Parameters in the Finger-Assisted,
although the follow-up period may not have been long
Single-Port Transvesical Enucleation
of the Prostate and Transurethral Resection enough. Occasionally after surgery for BPH via the transur-
of the Prostate Groups ethral route, persistent residual symptoms (dysuria and
frequency) exist because of urethral problems. Therefore,
F-STEP TURP P F-STEP will also be suitable for patients for whom concerns
(N ¼ 32) (N ¼ 67) value exist for urethral problems and urethral strictures.
All procedures were performed without any irrigation
Hospital stay (days) 3.02 Æ 4.56 1.90 Æ 3.82 0.14
fluids, thereby eliminating the transurethral resection syn-
Catheterization 5.31 Æ 0.76 2.09 Æ 1.74 0.03
time (days) drome. Bleeding was effectively controlled with pneumove-
IPSS recovery 5.54 Æ 2.85 10.88 Æ 20.94 0.01 sicum formation and enucleation under direct vision,
period (week) achieving adequate hemostasis.
Blood loss (mL) 176.54 Æ 14.11 126.54 Æ 14.60 0.07 Although minimally invasive, prostatic adenomas can be
Operative time (min) 109.42 Æ 44.48 68.03 Æ 25.02 0.02 completely enucleated via F-STEP as via open surgery. In this
Specimen weight (g) 48.35 Æ 21.12 29.85 Æ 13.41 0.03 study, the average extracted specimen weight was
Specimen=TRUS 76.70 48.87 0.02 48.35 Æ 21.12 g, and the specimen=TRUS size was 76.70%,
size (%) which was significantly greater than the TURP group. As
F-STEP ¼ finger-assisted single-port enucleation of the prostate; mentioned in the STEP study,8 finger dissection was highly
TURP ¼ transurethral resection of the prostate; IPSS ¼ International effective in dissecting adenomas. The finger-assisted proce-
Prostate Symptom Score; TRUS ¼ transrectal ultrasonography. dure was similar to the open technique, easily adapted, and

5. SINGLE-PORT TRANSVESICAL ENUCLEATION OF THE PROSTATE 463
the learning curve was steep. A recent study by Desai and 5. Servadio C. Is open prostatectomy really obsolete? Urology
associates22 addressed outcomes after STEP; finger assistance 1992;40:419–421.
was effectively used to expedite enucleation of the distal 6. Baumert H, Ballaro A, Dugardin F, Kaisary AV. Laparo-
apical portion in some cases. Fingertip dissection was not only scopic versus open simple prostatectomy: A comparative
sensitive in identifying the surgical plane, but finger dissec- study. J Urol 2006;175:1691–1694.
tion effectively extracted the prostate and reduced the oper- 7. Serretta V, Morgia G, Fondacaro L, et al. Open prostatec-
ative time to within 2 hours. We applied this technique in all tomy for benign prostatic enlargement in southern Europe in
cases (F-STEP). the late 1990s: A contemporary series of 1800 interventions.
Grade 3 IPP was a clinical predictor of higher symptoms Urology 2002;60:623–627.
8. Desai MM, Aron M, Canes D, et al. Single-port transvesical
and need for surgery.23 Lee and colleagues24 reviewed grade 3
simple prostatectomy: Initial clinical report. Urology 2008;
IPP 10.4 odds ratio for BPH progression. Therefore, complete
72:960–965.
resection of intravesical protruding adenoma was important
9. Sandhu JS, Ng C, Vanderbrink BA, et al. High-power
for BPH surgery. The rate of reoperation after TURP, how- potassium-titanyl-phosphate photoselective laser vaporiza-
ever, has been reported to be nearly 2% each year to remove tion of prostate for treatment of benign prostatic hyperplasia
recurrent adenomas.25 Our concept for complete resection in men with large prostates. Urology 2004;64:1155–1159.
with capsular margin would be ideal for grade 3 IPP BPH; in 10. Yuen JS, Ngiap JT, Cheng CW, Foo KT. Effects of bladder
our study, the reoperative rate was zero, but long-term ob- volume on transabdominal ultrasound measurements of
servation is needed for verification of this finding. intravesical prostatic protrusion and volume. Int J Urol 2002;
The average hospital stay was 3.02 days for F-STEP and 9:225–229.
1.90 days for TURP. Hospital stays are relatively longer in 11. Park YH, Kang MY, Jeong MS, et al. Laparoendoscopic
F-STEP without statistical significance, because most patients single-site nephrectomy using a homemade single-port de-
requested discharge after catheter removal. In Korea, insur- vice for single-system ectopic ureter in a child: Initial case
ance covers hospitalization for the most part, and relatively report. J Endourol 2009;23:833–835.
longer hospital stays result from pressure by the patients. 12. Han WK, Park YH, Jeon HG, et al. The feasibility of lapar-
oendoscopic single-site nephrectomy: Initial experience using
Conclusion home-made single-port device. Urology 2010;76:862–865.
13. Dawkins GP, Miller RA. Sorbitol-mannitol solution for
F-STEP is a very effective, safe, straightforward, modifica- urological electrosurgical resection—a safer fluid than gly-
tion of STEP. In addition, F-STEP is suitable for prostate cine 1.5%. Eur Urol 1999;36:99–102.
glands that are moderate to large with protruding adenoma. 14. Mebust WK, Holtgrewe HL, Cockett AT, Peters PC. Trans-
Intraoperative bleeding during F-STEP is minimal because of urethral prostatectomy: Immediate and postoperative com-
the reduced venous bleeding controlled by the CO2 pneu- plications. Cooperative study of 13 participating institutions
movesicum and more accurate dissection under direct vision. evaluating 3,885 patients. 1989. J Urol 2002;167:5–9.
The finger-assisted procedure is more convenient and reduces 15. de la Rosette JJ, Alivizatos G, Madersbacher S, et al. EAU
the operative time. Most of all, there were no urethral prob- Guidelines on benign prostatic hyperplasia (BPH). Eur Urol
lems during BPH surgery. The current study, however, is 2001;40:256-264.
limited by its nonrandomized nature. Also, the follow-up 16. Sotelo RJ, Astigueta JC, Desai MM, et al. Laparoendoscopic
period is short in our analysis. Therefore, further studies with single-site surgery simple prostatectomy: Initial report. Ur-
a randomized large number of patients and longer follow-up ology 2009;74:626–630.
are warranted to assess the use of this procedure in the sur- 17. Rehman J, Khan SA, Sukkarieh T, et al. Extraperitoneal
gical management of BPH. laparoscopic prostatectomy (adenomectomy) for obstructing
benign prostatic hyperplasia: Transvesical and transcapsular
(Millin) techniques. J Endourol 2005;19:491–496.
Disclosure Statement 18. Tan AH, Gilling PJ. Holmium laser prostatectomy: Current
techniques. Urology 2002;60:152–156.
No competing financial interests exist. 19. Tan A, Liao C, Mo Z, Cao Y. Meta-analysis of holmium laser
enucleation versus transurethral resection of the prostate for
References symptomatic prostatic obstruction. Br J Surg 2007;94:1201–1208.
20. Hammadeh MY, Madaan S, Hines J, Philp T. 5-year outcome
1. Zhou LY, Xiao J, Chen H, et al. Extraperitoneal laparoscopic of a prospective randomized trial to compare transurethral
adenomectomy for benign prostatic hyperplasia. World J electrovaporization of the prostate and standard transure-
Urol 2009;27:385–387. thral resection. Urology 2003;61:1166–1171.
2. Chang CM, Moon D, Gianduzzo TR, Eden CG. The impact 21. Rassweiler J, Teber D, Kuntz R, Hofmann R. Complications
of prostate size in laparoscopic radical prostatectomy. Eur of transurethral resection of the prostate (TURP)—incidence,
Urol 2005;48:285–290. management, and prevention. Eur Urol 2006;50:969–980.
3. Aron M, Goel R, Gautam G, et al. Percutaneous versus 22. Desai MM, Fareed K, Berger AK, et al. Single-port transve-
transurethral cystolithotripsy and TURP for large prostates sical enucleation of the prostate: A clinical report of 34 cases.
and large vesical calculi: Refinement of technique and up- BJU Int 2010;105:1296–1300.
dated data. Int Urol Nephrol 2007;39:173–177. 23. Lieber MM, Jacobson DJ, McGree ME, et al. Intravesical
4. Park JK, Lee SK, Han SH, et al. Is warm temperature nec- prostatic protrusion in men in Olmsted County, Minnesota.
essary to prevent urethral stricture in combined transure- J Urol 2009;182:2819–2824.
thral resection and vaporization of prostate? Urology 2009; 24. Lee LS, Sim HG, Lim KB, et al. Intravesical prostatic pro-
74:125–129. trusion predicts clinical progression of benign prostatic en-

6. 464 OH AND PARK
largement in patients receiving medical treatment. Int J Urol
2010;17:69–74. Abbreviations Used
25. Jung P, Mattelaer P, Wolff JM, et al. Visual laser ablation of BPH ¼ benign prostatic hyperplasia
the prostate: Efficacy evaluated by urodynamics and com- F-STEP ¼ finger-assisted, single-port transvesical
pared to TURP. Eur Urol 1996;30:418–423. enucleation of the prostate
IPP ¼ intravesical prostatic protrusion
IPSS ¼ International Prostate Symptom Score
Address correspondence to: Qmax ¼ maximum uroflow rate
Dong Soo Park, M.D., Ph.D. QoLs ¼ quality-of-life score
Department of Urology PSA ¼ prostate-specific antigen
CHA Bundang Medical Center PVR ¼ postvoid residual
CHA University STEP ¼ single-port transvesical encucleation
351 Yatap-dong, Bundang-gu of the prostate
Seongnam-si, 463-712 TRUS ¼ transrectal ultrasonography
Korea TURP ¼ transurethral resection of the prostate
VAS ¼ visual analogue scale
E-mail: dsparkmd@cha.ac.kr