Giant prostatic hyperplasia (GPH), defined as prostate volume ≥500 ml, is exceptionally rare, with fewer than 40 cases reported since 1919 [1]. Management has traditionally relied on open surgery or conservative drainage [2–4], while minimally invasive approaches for glands of this magnitude remain uncommon [5–9].
We present a video demonstration of single-port transvesical enucleation of the prostate (STEP) [10, 11] performed in an 83-year-old man with severe lower urinary tract symptoms, chronic catheterization, and a 903-ml prostate on magnetic resonance imaging. Due to extensive prior abdominal surgery, a transvesical, extraperitoneal single-port approach was selected [12, 13]. Key technical steps included modified transvesical access to optimize working space, staged cut-and-roll enucleation of a massive intravesical median lobe, Foley-assisted suction for hemostatic control in hypervascular tissue, and low-pressure pneumovesicum to facilitate bladder neck reconstruction [10].
Total console time was 280 minutes with an estimated blood loss of 600 ml requiring transfusion. A total of 570 g of adenoma was removed, with pathology confirming benign prostatic hyperplasia. Continuous bladder irrigation was not required. The patient was discharged on postoperative day 4, with catheter removal on day 9. At 3 months, he was continent with marked symptom improvement and PSA 0.43 ng/ml. At 9 months, he remained symptom-free with a maximum urine flow rate of 15.1 ml/s and post-void residual 31 ml.
This video highlights technical adaptations that enable safe single-port transvesical enucleation in extreme GPH. STEP may represent a feasible minimally invasive alternative to open surgery in selected patients, including those with hostile abdomens, when performed in experienced centers.