Robot-assisted simple prostatectomy for treatment of lower urinary tract symptoms secondary to benign prostatic enlargement: surgical technique and outcomes in a high-volume robotic centre

Abstract

Background: Robot-assisted simple prostatectomy (RASP) is a minimally invasive procedure for treatment of patients with lower urinary tract symptoms (LUTS) due to large benign prostatic enlargement (BPE).

Objective: To present the perioperative and short-term functional outcomes of RASP in a large series of patients with LUTS due to BPE treated in a high-volume referral center.

Design, setting, and participants: We retrospectively collected data for 67 consecutive patients who underwent RASP from October 2008 to August 2014.

Surgical procedure: RASP was performed using a Da Vinci S or Si system with a transvesical approach.

Measurements: Complications were graded according to the Clavien-Dindo system. Continuous variables are reported as median and interquartile range (IQR). Comparison of preoperative and postoperative outcomes was assessed by Wilcoxon test. A two-sided value of p<0.05 was considered statistically significant.

Results and limitations: The median preoperative prostate volume was 129ml (IQR 104-180). For the 45 patients who did not have an indwelling catheter, the median preoperative International Prostate Symptom Score (IPSS) was 25 (20.5-28), the median maximum flow rate (Qmax) was 7ml/s (IQR 5-11), and the median post-void residual volume (PVRV) was 73ml (IQR 40-116). The median operative time was 97min (IQR 80-127) and the median estimated blood loss was 200ml (IQR 115-360). The postoperative complication rate was 30%, including three cases (4.5%) with grade 3b complications (major bleeding requiring cystoscopy and coagulation). The median catheterization time was 3 d (IQR 2-4) and the median length of stay was 4 d (IQR 3-5). The median follow-up was 6 mo (IQR 2-12). At follow-up, the median IPSS was 3 (IQR 0-8), the median Qmax was 23ml/s (IQR 16-35), and the median PVRV was 0ml (IQR 0-36) (all p<0.001 vs baseline values). The retrospective design is the major study limitation.

Conclusions: Our data indicate good perioperative outcomes, an acceptable risk profile, and excellent improvements in patient symptoms and flow scores at short-term follow-up following RASP.

Patient summary: We analyzed the perioperative and functional outcomes of robot-assisted simple prostatectomy in the treatment of male patients with lower urinary tract symptoms due to large prostatic adenoma. The procedure was associated with a relatively low risk of complications and excellent functional outcomes, including considerable improvements in symptoms and flow performance. We can conclude that the procedure is a valuable option in the treatment of such patients. However, comparative studies evaluating the efficacy of the procedure in comparison with endoscopic treatment of large prostatic adenomas are needed.

Keywords: Benign prostatic hyperplasia; Lower urinary tract symptoms; Robotic; Simple prostatectomy.