BACKGROUND AND OBJECTIVE:The Retzius-sparing (RS) robot-assisted radical prostatectomy (RARP) was proposed in 2010 to enhance early postoperative continence recovery. However, long-term oncological outcomes following this approach remain insufficiently characterized. This study reports the long-term oncological outcomes of a randomized controlled trial originally designed to compare early continence recovery in patients treated using the RS versus standard (anterior) approach. DESIGN, SETTING, PARTICIPATNS AND INTERVENTION:A total of 120 men aged 40-75 yr with low- to intermediate-risk prostate cancer underwent RARP at a tertiary referral center. Patients were randomized 1:1 to the anterior or RS approach (n = 60 per arm). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS:The primary end point was progression-free survival (PFS), defined as biochemical recurrence and/or the need for any additional treatment. Kaplan-Meier plots were used to depict and compare PFS between the approaches. Cox regression was used to examine the impact of the approach on PFS after adjusting for the Cancer of the Prostate Risk Assessment Postsurgical (CAPRA-S) scores. RESULTS AND LIMITATIONS:Median follow-up was 77 mo (interquartile range 30-110). At 5 yr, PFS was 80.2% in the RS group versus 91.1% in the anterior group (p = 0.01). After adjusting for CAPRA-S score, patients undergoing the RS approach were 2.64-fold more likely to experience progression (p = 0.049). The main limitations of this study stem from its original design, which did not consider long-term oncological outcomes as a primary end point, and from surgeons' limited prior experience with the RS approach. CONCLUSIONS:Although RS RARP provides superior early continence outcomes, patients randomized to this approach experienced less favorable long-term oncological control, potentially because of the increased technical demands of the procedure.

Introduction The Menon precision prostatectomy procedure (MPP) is a novel subtotal gland treatment for prostate cancer (PCa) that involves unilateral preservation of the prostate capsule and seminal vesical with radical resection of the contralateral gland containing the patient's dominant site of disease. This form of prostate cancer treatment aims to preserve post-operative erectile function, which is commonly compromised in patients undergoing traditional radical prostatectomy. Because of the subtotal nature of MPP, patients may continue to experience a detectable PSA level postoperatively. We explored the prognostic significance of a detectable PSA level at 6-12 weeks after PP. Methods Patients with grade group ≤ 3 prostate cancer and a PSA level ≤ 20 ng/ml who prioritized maintenance of erectile function were offered MPP as part of an IRB approved prospective single-arm study. As part of the study protocol, patients underwent an initial PSA test between 6 – 12 weeks, followed by 3-monthly PSA testing and biopsy of the remnant prostate at 10 - 18 months post-operatively regardless of initial post-operative PSA level. Patients with grade group 2 or higher prostate cancer at the time of remnant biopsy were offered treatment with completion prostatectomy or salvage radiation therapy. Kaplan-Meier analysis was performed to assess for freedom from treatment failure after dichotomization by presence or absence of a persistently elevated post-operative PSA level, defined as PSA > 0.1 ng/mL at 6 – 8 weeks. Logistic regression analysis was subsequently performed to identify factors associated with persistent post-operative PSA. Results Between 2016 and 2020, 128 patients underwent MPP. In total, 78 patients had a persistently elevated PSA level after surgery. Patients with a persistently elevated PSA level had a higher hazard of treatment failure compared to individuals with an initial post-operative PSA of <0.1 ng/mL (Figure 1). Among the preoperative factors analyzed, preoperative PSA level had the strongest association with a persistently elevated PSA level following MPP (Table 1). Conclusions Patients with a detectable PSA level have a higher likelihood of treatment failure after PP. These patients must be carefully followed with regular PSA testing and timely biopsies of the prostatic remnant. Preoperative PSA may have a predictive role in identifying patients at highest risk for a persistently elevated PSA level after PP.

Prostate cancer is characterized by remarkable molecular heterogeneity associated with disease progression and clinical outcomes. We have identified distinct molecular subtypes between CA and AA in biomarker expression associated with altered clinical outcomes. This study compares the effectiveness of standard 12-core biopsy and saturation biopsy in identifying molecular subtypes of prostate cancer and evaluating biomarker expression patterns across racial groups. We analyzed 104 cases that underwent saturation biopsies (median min, max 23 [14, 27], cores with cancer (median 11 [5, 25] and compared them with 130 cases with standard 12-core biopsies (median min, max 12 [12, 16]; cores with cancer median min, max 4 [1, 16] using ERG, ETV1, ETV4 and SPINK1 by combined multiplex IHC and RNA ISH. Saturation biopsy demonstrated superior detection of molecular subtypes, identifying higher rates of SPINK1- and ETV4-positive tumor foci than standard biopsy (p <.001). It also reduced the frequency of negative cases for all four biomarkers, indicating a higher prevalence of ETS gene fusions in prostate cancer (94%) than was reported previously. Caucasian American (CA) patients exhibited higher frequencies of ERG- and ETV1-positive tumor foci, while African American (AA) patients showed higher frequencies of SPINK1- and ETV4-positive foci and presented with higher Gleason Grade Groups at the time of biopsy. ERG positivity was associated with lower Gleason Grade Groups in both racial groups (CA p=.004; AA p <.001), and ETV1 positivity was linked to higher Gleason Grade Groups (CA p<.001; AA p<.001). These findings concord with our previous observations on the association of ETV1 And ETV4 with worse recurrence-free survival in CA and AA, respectively, underscoring significant racial variations in prostate cancer biology and the prognostic implications of biomarker expression. Saturation biopsy identified 16 distinct molecular subtypes with one or more than one ETS gene fusion, compared with 13 detected by standard 12-core biopsy. By uncovering a greater diversity of tumor subtypes, saturation biopsy highlights the extent of complex tumor heterogeneity and prostate cancer biology. It reveals fewer cases classified as ETS fusions compared with standard biopsies. This study demonstrates that saturation biopsy is a more effective diagnostic tool for detecting molecular subtypes and evaluating tumor heterogeneity in prostate cancer. The enhanced detection of subtype diversity and its ability to identify biomarker expression patterns associated with racial disparities underscores the potential of saturation biopsy in guiding precision oncology. These findings have profound implications for improving diagnostic accuracy, addressing racial inequality, and informing tailored treatment strategies for prostate cancer patients. Wei Zhao, Pin Li, Shannon Carskadon, Jessica Ryba, Hristina Trpevski, Vishnav Ramesh, Dhananjay Chitale, Firas Abdollah, Wooju Jeong, Craig Rogers, Daniel Isaac, Nilesh Gupta, Nallasivam Palanisamy. Enhanced detection of molecular subtypes in prostate cancer using saturation biopsy: Insights into tumor heterogeneity and racial disparities [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 3893.

Detection of advanced renal cell carcinoma (RCC) is not uncommon, although there has been a stage migration due to frequent use of abdominal imaging allowing early detection of renal masses. Since open IVC thrombectomy was introduced in 1972, minimally invasive approaches such as laparoscopic approach, hand-assisted approach and robotic approach have been adopted. While robotic surgery has potential benefits to improve perioperative outcomes, and our experience with robotic surgery has grown significantly over the last decade, open surgery at an academic center remains the standard of care in this setting. In the setting of metastatic RCC, cytoreductive nephrectomies have been discussed for many years but their indications are unclearly defined, although cytoreductive nephrectomy can be considered in patients with disease largely limited to the kidney or on-going or impending symptomatic disease. Significant advances have been made in systematic therapy for RCC which will eventually lead to the evolution of neoadjuvant and adjuvant therapy in patients with advanced RCC. The surgical management of advanced RCC is a major and complex undertaking but has shown to be feasible and effective.

AbstractObjectivesThis study aimed to assess postoperative decision regret (DR) after precision prostatectomy (PP), a novel subtotal surgical technique for prostate cancer (PCa) that involves the preservation of the unilateral capsule and seminal vesicle, and to identify factors predictive of DR after PP.Materials and MethodsAfter a shared decision‐making process, 128 patients underwent PP for the treatment of localised PCa. Given the subtotal nature of the surgery, patients were informed about the possibility of a detectable prostate‐specific antigen and secondary treatment. Between 6 and 12 months of follow‐up, DR was analysed using the previously validated decision regret score (DRS). A univariable linear regression analysis was performed to analyse factors predictive of DR after PP.ResultsBetween 6 and 12 months after PP, objective measurements of DR were obtained on 64 patients who completed the DRS. At the time of DRS, 16 patients were impotent (SHIM < 17), while six were incontinent (≥1 pad/day). The median time to DRS was 10 months (IQR 7.5–11.8). Only two patients (3.1%) reported significant DR after PP (DRS > 25), while 53 patients (83%) reported no regret (DRS = 0). The median DRS was 0 (0–0). Incontinence and impotence at the time of DRS predicted higher DR after PP (incontinence estimate: 11.3 ± 3.2, p < 0.001; impotence estimate: 5.4 ± 2.3, p = 0.02).ConclusionsThe incidence of DR after PP is low, with only 3% of patients reporting significant regret. Patients who are either incontinent or impotent after PP are more likely to regret their decision. Further studies with larger sizes and longer follow‐ups are required to measure the longitudinal trends in DR after PP.

You have accessJournal of UrologyProstate Oncology/Penile & Testis Oncology/Misc. Oncology I (V09)1 May 2024V09-06 IMPACT OF A NOVEL ANTERIOR SUSPENSION STITCH ON RETURN OF URINARY CONTINENCE AFTER ROBOTIC RADICAL PROSTATECTOMY (RRP), WITH DESCRIPTION OF SURGICAL TECHNIQUE Sohrab Arora, Yuzhi Wang, Samantha Wilder, Emily Fisher, Alex Stephens, James O. Peabody, and Wooju Jeong Sohrab AroraSohrab Arora , Yuzhi WangYuzhi Wang , Samantha WilderSamantha Wilder , Emily FisherEmily Fisher , Alex StephensAlex Stephens , James O. PeabodyJames O. Peabody , and Wooju JeongWooju Jeong View All Author Informationhttps://doi.org/10.1097/01.JU.0001009528.33572.9e.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: During radical prostatectomy, the pubourethral angle is increased due to the loss of periprostatic supportive tissue, and the symphysis to bladder neck distance is increased due to the loss of prostatic urethral length. We hypothesize that recreating the pubourethral angle and decreasing the symphysis to bladder neck distance during RRP improves continence outcomes. We achieved this by performing an anterior suspension stitch ("Jeong suspension"). METHODS: 41 patients underwent 'Jeong suspension' (suspension group) by two surgeons at a single institution between 2017-2021. In this suspension procedure, the anterior bladder wall attached to the symphysis of pubis is identified during the bladder takedown. This point is then suspended to the symphysis pubis after anastomosis, pulling the urethrovesical anastomosis anterior and superior, restoring the periurethral anatomy. Outcomes were compared to contemporary 2:1 propensity-score matched patients who did not undergo 'Jeong suspension' (control). The patients were administered validated questionnaires at 1, 3, 6, and 12 months after the procedure and social Continence defined as the use of no pads or one security pad. Outcomes were assessed independently by a state-wide quality collaborative. Kaplan Meier analysis was used to calculate median time to continence in weeks. Cox regression tested the effect of 'Jeong stitch' accounting for known confounders. RESULTS: After propensity score matching, groups were similar in all baseline variables, except PSA which was statistically, but not clinically higher in suspension group (mean 12 ng/dl vs 9 in control; p<0.01). 36 patients in the suspension group achieved continence (88%), compared to 58 (71%) in control group. Median time to social continence was 20 weeks for suspension group, compared to 36 for control; p=0.003. Cox regression confirmed independent association of suspension to continence [HR 1.90 (CI 1.24-2.92)]. CONCLUSIONS: The Jeong suspension stitch during RRP is technically easy-to-perform and safe. This stitch significantly improves time to social continence when compared to matched patients not undergoing the technique. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e637 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Sohrab Arora More articles by this author Yuzhi Wang More articles by this author Samantha Wilder More articles by this author Emily Fisher More articles by this author Alex Stephens More articles by this author James O. Peabody More articles by this author Wooju Jeong More articles by this author Expand All Advertisement PDF downloadLoading ...

Introduction: Retzius-sparing prostatectomy was promoted with the early continence result. The long-term oncologic outcome is still unknown. In this study, we aimed to compare the intermediate-term oncologic outcomes of these two approaches in patients' cohort who were treated as part of a randomized controlled trial. Methods: A total of 120 patients were previously randomized equally to receive Retzius-sparing robot-assisted laparoscopic radical prostatectomy (RS-RARP) vs standard robot-assisted laparoscopic radical prostatectomy (S-RARP) between January 2015 and April 2016. Baseline, surgical, and pathologic characteristics as well as oncologic outcomes were assessed. The analysis was done based on the treatment received. Result: Sixty-three patients underwent S-RARP, whereas 57 patients underwent RS-RARP. There was no statistically significant difference in the baseline nor surgical characteristics. The median follow-up was 71.24 (interquartile range: 59.75-75.75) months. There were more pathologic T3 diseases in RS-RARP. There was no significant difference in the positive margin status nor in the biochemical recurrence (BCR) rate among both groups. After S-RARP and RS-RARP, 6 and 10 patients had BCR, and the 5 years BCR-free survival was 91% and 85%, respectively (p = 0.21). Conclusion: In this cohort, there was no difference in BCR in the patients who received either technique. Further multi-institutional studies with a larger sample size and longer follow-up are required.

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy II (MP52)1 May 2024MP52-16 COMPARATIVE OUTCOMES OF STANDARD AND MODIFIED RADICAL PROSTATECTOMY AT 5-7 YEARS OF FOLLOW-UP Kaushik P. Kolanukuduru, Shane Tinsley, Akshay Sood, Firas F. Abdollah, Wooju Jeong, and Mani Menon Kaushik P. KolanukuduruKaushik P. Kolanukuduru , Shane TinsleyShane Tinsley , Akshay SoodAkshay Sood , Firas F. AbdollahFiras F. Abdollah , Wooju JeongWooju Jeong , and Mani MenonMani Menon View All Author Informationhttps://doi.org/10.1097/01.JU.0001008864.84854.b7.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Precision Prostatectomy (Precision Prostatectomy - MPP) is a form of surgical subtotal gland therapy that involves the removal of 90-95% of the prostate while preserving the capsule and the seminal vesicle contralateral to the dominant lesion. We present the oncological and functional outcomes at a median follow-up of 5 years in the first 100 patients undergoing MPP. We compare the results to a group of patients who were candidates for MPP but chose to undergo conventional radical prostatectomy (the modelling cohort - RP). METHODS: From 2017-2021, precision prostatectomy was offered to men with dominant unilateral cancer (Gleason ≤4+3) prostate cancer and a Prostate Specific Antigen (PSA) of ≤20 ng/ml, who placed a high priority on maintaining erectile function in an IRB-approved study. Patients who refused underwent a conventional radical prostatectomy, with removal of both seminal vesicles. The follow-up period was 5-7 years. RESULTS: There were 100 patients in each cohort. Table 1 lists the baseline characteristics of the two groups. The median age was 60 and 61.5 in both groups, these patients had a median follow-up of 60 months and 68.5 months. The median pre-operative PSA was 5.7 ng/ml and 5.3 ng/ml in the respective groups, and the PSA at the median follow-up was 0.04 ng/ml and <0.01 ng/ml respectively. The functional and oncological follow up is shown in the Figure 1. MPP was non-inferior to RP in the positive margin rates, freedom from secondary treatment, BCR or 12-month continence rates. However, MPP was superior to RP in the requirement for salvage radiation/hormones, early continence, and erectile function. CONCLUSIONS: The freedom from progression rates after MPP were comparable to RP in patients with intermediate-risk prostate cancer (88%, 91%). Recurrences after MPP were treated with excision of the remnant, whereas recurrences after RP were treated with radiation and hormone therapy. Download PPT Source of Funding: No sources of funding to disclose © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e859 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Kaushik P. Kolanukuduru More articles by this author Shane Tinsley More articles by this author Akshay Sood More articles by this author Firas F. Abdollah More articles by this author Wooju Jeong More articles by this author Mani Menon More articles by this author Expand All Advertisement PDF downloadLoading ...

Background: Robotic kidney transplantation (RKT) is a novel and welcomed innovation yielding good surgical outcomes. However, data on the feasibility and safety of performing RKT by surgeons with a lack of prior minimally invasive surgery (MIS) experience are limited. The authors aimed to evaluate the surgical and functional results of RKT and present the learning curves (LC) of RKT by a single surgeon with no prior experience in MIS. Materials and methods: This was a retrospective study of all RKT performed between November 2019 and April 2023 at Severance Hospital in Seoul, South Korea. The authors analyzed surgical and functional outcomes, as well as complication rates of RKT in comparison to open kidney transplantation (OKT). The authors evaluated LCs using the cumulative summation method to describe the number of cases associated with the competency of a single surgeon. Results: A total of 50 patients who underwent RKT and 104 patients who underwent OKT were included in this study. In RKT group, the median surgical console time was 193 min (interquartile range, 172–222) and the median vascular anastomoses time was 38 min (35–44). Total operation time was 323 min (290–371) and rewarming time was 62.5 min (56.0–70.0) in RKT group compared to 210 min (190–239) and 25 min (21–30), respectively, in OKT group. Despite extended surgical durations with a robotic technique, both groups had comparable intraoperative and postoperative outcomes, as well as renal function. Estimated blood loss and post-transplant hospital stays were significantly lower in RKT group than in OKT group. LC analysis of RKT by the single surgeon revealed that surgical competence was achieved after 15 cases. Conclusion: Even if surgeons do not have prior experience with MIS, they can rapidly overcome the LC and safely perform RKT with adequate preparation and acquisition of basic robotic surgical techniques.

Abstract Introduction Myofascial pelvic pain is a major component of chronic pelvic pain. Effective treatments are available to reduce pain, including myofascial tender point release. The study investigated the safety, feasibility and early outcomes of releasing myofascial tender point by polydioxanone thread and platelet rich plasma treatment in myofascial pelvic pain patients. Methods Twenty myofascial pelvic pain patients underwent polydioxanone thread and platelet rich plasma treatment. After autologous platelet rich plasma was injected into the pelvic muscles through vaginal access, a multi-braided polydioxanone thread was inserted into the middle and deep layers of the pelvic muscles. Pre- and post-procedural satisfaction surveys and Female Sexual Function Index scores (FSFI) were obtained. Vaginal manometry measured mobility and pressure of pelvic floor muscles. The patients were followed-up at 3 and 6 months after the procedure. Results At 3-months after the procedure, 65% of the patients answered positively on the improvement of symptoms and tenderness, 35% answered no difference, and none answered worsening. At this period, FSFI did not show a significant change in any of the six categories. After six months, however, there was a statistically significant improvement in all the indices except for sexual desire (p < 0.05). Conclusions Pelvic floor muscle targeted polydioxanone thread insertion and platelet rich plasma injection is safe and feasible, and may minimize pelvic pain without side effects such as infection or bleeding. It may potentially improve urinary control and sexual function by releasing myofascial tenderness.

BACKGROUND:Estimation of life expectancy (LE) is important for the relative benefit of prostate specific antigen (PSA) screening. Limited data exists regarding screening for Black men with extended LE. The aim of the current study was to assess temporal trends in screening in United States (US) Black men with limited vs. extended LE, using a nationally representative dataset. MATERIALS AND METHODS:Using the National Health Institution Survey (NHIS) 2000 to 2018, men aged ≥40 without prior history of prostate cancer (PCa) who underwent PSA screening in the last 12 months were stratified into limited LE (ie, LE <15 years) and extended LE (ie, LE≥15 years) using the validated Schonberg index. LE-stratified temporal trends in PSA screening were analyzed for all men, and then in Black men. Weighted multivariable analyses and dominance analyses identified the predictors of PSA screening. RESULTS:PSA screening declined over the study period both for all eligible men with limited and extended LE, particularly between NHIS 2008 and 2013 (27.9%-20.7% in the extended). Screening increased significantly in Black men with extended LE (17.6% in 2010-25.7% in 2018). However, LE was not an independent predictor of screening in the Black cohort. Prior recipient of colonoscopy (55%-57%) and visit to health care provider (24%-32%) were the most important determinants for screening. CONCLUSION:For US men with extended LE, only 1 in 4 receive PSA screening, with a decline over the study-period. Screening rates increased for Black men. However, these changes were not driven by LE consideration itself, but participation in other screenings and access to a provider.

BackgroundAn informed decision regarding a treatment option requires data on its long-term efficacy and side-effect profile. While the side-effects of robotic radical prostatectomy have been well-quantified, the data on its long-term efficacy are lacking. We here provide 15-year oncological outcomes of clinically-localized prostate cancer (CLPCa) patients treated with robot-assisted laparoscopic prostatectomy (RALP).MethodsWe treated 1,807 men with CLPCa with RALP between 2001 and 2005 and prospectively collected follow-up data through 2020. We examined the rates of biochemical failure (BCF), metastatic progression, secondary therapy use, PCa-specific mortality (PCSM), and overall survival (OS) using Kaplan-Meier and competing-risk cumulative incidence methods as appropriate.ResultsThe median follow-up was 14.1 years. Six hundred eight and 312 men had D'Amico intermediate- and high-risk disease, respectively. Overall, the 15-year rates of BCF, metastasis, secondary therapy use, PCSM, and OS were 28.1%, 4.0%, 16.3%, 2.5%, and 82.1%, respectively. The rates of oncologic failure increased with increasing D'Amico (preoperative) and Diaz (postoperative) risk scores - BCF, metastasis, and PCSM rates in D'Amico low-, intermediate-, and high-risk groups at 15-years were 15.2%, 38.3%, and 44.1% [BCF], 1.1%, 4.1%, and 13.0% [metastasis], and 0.5%, 3.4%, and 6.6% [PCSM], respectively, and in Diaz risk groups 1, 2, 3, 4, and 5 were 5.5%, 20.6%, 41.8%, 66.9%, and 89.2% [BCF], 0%, 0.5%, 3.2%, 20.5%, and 60.0% [metastasis], and 0%, 0.8%, 0.6%, 13.5%, and 37.5% [PCSM], respectively. The OS rates in D'Amico low-to-high and Diaz 1-to-5 risk groups at 15-years were 85.9%, 78.6%, and 75.2%, and 89.4%, 83.2%, 80.6%, 67.2%, and 23.4%, respectively.ConclusionsMen diagnosed with clinically-localized prostate cancer in the contemporaneous PSA-screening era and treated with RALP achieve durable long-term oncological control. The data reported here (in a risk-stratified manner) represent the longest follow-up after robotic radical prostatectomy, and as such, should be of value when counseling patients regarding expected oncologic outcomes from RALP.

You have accessJournal of UrologyCME1 Apr 2023V10-03 OUTCOMES OF PRECISION PROSTATECTOMY PROCEDURE FOR LOCALIZED PROSTATE CANCER, AND STEP-BY-STEP TECHNIQUE OF SINGLE PORT TRANSVESICAL PRECISION PROSTATECTOMY Sohrab Arora, Samantha Wilder, Mohit Butaney, Craig Rogers, and Wooju Jeong Sohrab AroraSohrab Arora More articles by this author , Samantha WilderSamantha Wilder More articles by this author , Mohit ButaneyMohit Butaney More articles by this author , Craig RogersCraig Rogers More articles by this author , and Wooju JeongWooju Jeong More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003328.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Whole-gland therapy is the mainstay of treatment for high-volume, low risk patients with prostate cancer (PCa), however it is associated with functional side effects. Precision prostatectomy is a surgical technique that removes >90% of prostatic tissue while preserving functional recovery. We describe a case of single port transvesical precision prostatectomy and report outcomes of patients who have received multiport precision prostatectomy at our institution. METHODS: A 72-year-old man with prior appendectomy and umbilical and hernia repair on active surveillance for left Grade Group 2 PCa elected to undergo surgery due to rising PSA. The following surgical steps are described: (1) transvesical access and robot docking, (2) anterograde bladder neck dissection, (3) standard dissection and nerve sparing on radical side, (4) development of precision plane, (5) apical dissection, (6) urethral transection, (7) posterior reconstruction, and (8) urethrovesical anastomosis. Oncological and functional outcomes of 88 patients with localized PCa undergoing multiport precision prostatectomy are reported. RESULTS: The patient underwent an uncomplicated single port transvesical precision prostatectomy, was discharged on post op day (POD) 1, and passed trial of void on POD 8. He was fully continent by 4 weeks post foley removal. The patient has not yet tried sexual activity postoperatively due to life events. 11-month follow-up shows a stable PSA of 0.7. All 88 patients undergoing multiport precision prostatectomy were alive and metastasis free at a median follow up of 25 months. At 36 months, 93% of patients were free from clinically significant residual PCa, 91% had not undergone additional treatment, and 100% were alive and metastasis-free. Two patients had biochemical failure according to Phoenix criteria, and 25 using the more stringent AUA post-RP criterion. However, detectable PSA was due to prostate cancer in only 10 patients as detected on biopsy of the remnant. Six patients underwent removal of the remnant and were free from biochemical failure at median follow-up of 10.2 months. At 12 months, 91% of patients were pad free, and 90% of the preoperatively potent patients had a SHIM score of 17+. CONCLUSIONS: Precision prostatectomy offers excellent postoperative functional results while minimizing PCa undertreatment. Single port transvesical precision prostatectomy is feasible and safe in select patients. Close patient follow-up and investigation into long-term oncological outcomes are necessary. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e926 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sohrab Arora More articles by this author Samantha Wilder More articles by this author Mohit Butaney More articles by this author Craig Rogers More articles by this author Wooju Jeong More articles by this author Expand All Advertisement PDF downloadLoading ...