To report the treatment of a peculiar morphology of prostatic hyperplasia nodule-the extra-vesicle median lobe during robot-assisted radical prostatectomy.

Among the 339 cases of RARP performed by a single operator between July 2022 and June 2023, 238 cases with preserved surgical videos were reviewed, focusing on the bladder neck dissection and its subsequent dorsal prostate detachment procedures, and a total of 8 patients with typical extravesical median lobes were screened out for reviewing in combination with the patient's preoperative multiparametric magnetic resonance imaging data. In this article, we would focus on the analysis of one of the cases.

The extra-vesicle median lobe was usually located behind the urethra, and its anatomical location and texture were close to the contralateral vas deferens and seminal vesicles. During robot-assisted radical prostatectomy (RARP), it potentially misled the surgeon into the wrong anatomical plane. Due to the modification of the surgical plane, the operation time would probably be prolonged, which might impact the surgical determination of the surgeon.

How to predict the existence of "the extra-vesicle median lobe" before and during operation and make timely adjustment of surgical strategies is a problem worth exploring by surgeons.