A minimally invasive robotic reconstruction reserved for extreme, massive benign prostate enlargement (BPH). The obstructive inner core of the prostate gland is completely enucleated via precise robotic dexterity, leaving the outer capsule intact to relieve severe obstruction and retention while protecting surrounding pelvic nerve tissue.

Clinical Indication

This procedure is highly indicated for patients experiencing structural anomalies, severe localized scar tissue, or functional blockages that fail to resolve with initial conservative therapeutic adjustments.

Surgical Objective

The principal objective is the complete restoration of physiological form, functional urinary path independence, or mechanical integrity, maximizing long-term outcomes while minimizing systemic downtime.

Robotic Simple Prostatectomy (adenomectomy) is the definitive surgical solution for massive benign prostatic hyperplasia (BPH) with prostate glands exceeding 80 to 100+ grams. While transurethral resections (TURP) or laser therapies can be prolonged and carry higher bleeding risks in gigantic glands, robotic adenomectomy permits rapid, complete anatomical enucleation of the obstructing transition zone adenoma in a single, controlled minimally invasive procedure.

Clinical Indications & Patient Selection

Indicated for men with large-volume prostate adenomas causing severe bladder outlet obstruction who desire definitive, single-session clearance.

Prostate Volume >80–100 cc: Massive adenomas unsuitable for standard transurethral resection without prolonged resection times.

Secondary Bladder Pathologies: Concurrent large bladder diverticula or multiple large bladder calculi (stones) that can be removed simultaneously through the cystotomy.

Recurrent Refractory Retention & Hematuria: Inability to void without a catheter, or recurrent prostatic bleeding from prominent adenoma varices.

Surgical Technique & Procedural Nuance

Performed robotically via either a transvesical (through the bladder) or transcapsular (Millin) approach.

Robotic Capsulotomy / Cystotomy: The anterior prostate capsule or bladder dome is incised under 10x 3D magnification, revealing the surgical plane between the central adenoma and peripheral surgical capsule.

Blunt & Bipolar Adenoma Enucleation: The bilateral obstructing lobes and median lobe are precisely dissected off the outer capsule, preserving the distal external urinary sphincter muscle.

Trigonization & Capsule Closure: The bladder neck mucosa is advanced and sutured to the prostatic apex (trigonization) using 3-0 V-Loc sutures to ensure rapid mucosal coverage, prevent contracture, and achieve complete hemostasis.

Postoperative Pathway & Recovery Timeline

Conducted with an overnight hospital stay; most men ambulate comfortably on post-op day 1.

Catheter Duration: A 20Fr 3-way catheter is placed with continuous bladder irrigation for 12–24 hours, and removed in clinic at 5 to 7 days.

Immediate Stream Restoration: Patients experience a massive, immediate increase in flow rate and complete bladder emptying once the catheter is pulled.

Activity Restrictions: Heavy lifting (>20 lbs) and straining avoided for 3 to 4 weeks to prevent capsule bleeding.

Outcomes, Durability & Clinical Evidence

Provides the most durable relief of any BPH surgical option with virtually zero risk of adenoma recurrence.

Maximum Flow Improvement: Flow improves substantially and the bladder usually empties well afterward.

Zero Re-intervention: Near-zero lifetime reoperation rate because the entire benign adenoma is enucleated down to the surgical capsule.

Robotic Simple Prostatectomy (adenomectomy) is the definitive surgical solution for massive benign prostatic hyperplasia (BPH) with prostate glands exceeding 80 to 100+ grams. While transurethral resections (TURP) or laser therapies can be prolonged and carry higher bleeding risks in gigantic glands, robotic adenomectomy permits rapid, complete anatomical enucleation of the obstructing transition zone adenoma in a single, controlled minimally invasive procedure.

Clinical Indications & Patient Selection

Indicated for men with large-volume prostate adenomas causing severe bladder outlet obstruction who desire definitive, single-session clearance.

Prostate Volume >80–100 cc: Massive adenomas unsuitable for standard transurethral resection without prolonged resection times.

Secondary Bladder Pathologies: Concurrent large bladder diverticula or multiple large bladder calculi (stones) that can be removed simultaneously through the cystotomy.

Recurrent Refractory Retention & Hematuria: Inability to void without a catheter, or recurrent prostatic bleeding from prominent adenoma varices.

Surgical Technique & Procedural Nuance

Performed robotically via either a transvesical (through the bladder) or transcapsular (Millin) approach.

Robotic Capsulotomy / Cystotomy: The anterior prostate capsule or bladder dome is incised under 10x 3D magnification, revealing the surgical plane between the central adenoma and peripheral surgical capsule.

Blunt & Bipolar Adenoma Enucleation: The bilateral obstructing lobes and median lobe are precisely dissected off the outer capsule, preserving the distal external urinary sphincter muscle.

Trigonization & Capsule Closure: The bladder neck mucosa is advanced and sutured to the prostatic apex (trigonization) using 3-0 V-Loc sutures to ensure rapid mucosal coverage, prevent contracture, and achieve complete hemostasis.

Postoperative Pathway & Recovery Timeline

Conducted with an overnight hospital stay; most men ambulate comfortably on post-op day 1.

Catheter Duration: A 20Fr 3-way catheter is placed with continuous bladder irrigation for 12–24 hours, and removed in clinic at 5 to 7 days.

Immediate Stream Restoration: Patients experience a massive, immediate increase in flow rate and complete bladder emptying once the catheter is pulled.

Activity Restrictions: Heavy lifting (>20 lbs) and straining avoided for 3 to 4 weeks to prevent capsule bleeding.

Outcomes, Durability & Clinical Evidence

Provides the most durable relief of any BPH surgical option with virtually zero risk of adenoma recurrence.

Maximum Flow Improvement: Flow improves substantially and the bladder usually empties well afterward.

Zero Re-intervention: Near-zero lifetime reoperation rate because the entire benign adenoma is enucleated down to the surgical capsule.

Related Conditions & Patient Recovery Protocols

Clinical Subspecialty Hub: BPH & Advanced Voiding Therapies Hub →

Underlying Clinical Condition: Overactive Bladder →

Underlying Clinical Condition: Prostate Cancer Screening →