Is urethral-sparing robot-assisted simple prostatectomy ready for prime time?

You have accessJournal of UrologyCME1 Apr 2023MP59-07 IS URETHRAL-SPARING ROBOT-ASSISTED SIMPLE PROSTATECTOMY READY FOR PRIME TIME? Prata Francesco, Umberto Anceschi, Daniele Amparore, Andrea Iannuzzi, Alberto Ragusa, Alfredo Maria Bove, Leonardo Misuraca, Sabrina De Cillis, Checcucci Enrico, Aldo Brassetti, Silvia Cartolano, Ashanti Zampa, Simone D'annunzio, Riccardo Mastroianni, Giuseppe Spadaro, Gabriele Tuderti, Mariaconsiglia Ferriero, Salvatore Guaglianone, Rocco Papalia, Cristian Fiori, Francesco Porpiglia, and Giuseppe Simone Prata FrancescoPrata Francesco More articles by this author , Umberto AnceschiUmberto Anceschi More articles by this author , Daniele AmparoreDaniele Amparore More articles by this author , Andrea IannuzziAndrea Iannuzzi More articles by this author , Alberto RagusaAlberto Ragusa More articles by this author , Alfredo Maria BoveAlfredo Maria Bove More articles by this author , Leonardo MisuracaLeonardo Misuraca More articles by this author , Sabrina De CillisSabrina De Cillis More articles by this author , Checcucci EnricoCheccucci Enrico More articles by this author , Aldo BrassettiAldo Brassetti More articles by this author , Silvia CartolanoSilvia Cartolano More articles by this author , Ashanti ZampaAshanti Zampa More articles by this author , Simone D'annunzioSimone D'annunzio More articles by this author , Riccardo MastroianniRiccardo Mastroianni More articles by this author , Giuseppe SpadaroGiuseppe Spadaro More articles by this author , Gabriele TudertiGabriele Tuderti More articles by this author , Mariaconsiglia FerrieroMariaconsiglia Ferriero More articles by this author , Salvatore GuaglianoneSalvatore Guaglianone More articles by this author , Rocco PapaliaRocco Papalia More articles by this author , Cristian FioriCristian Fiori More articles by this author , Francesco PorpigliaFrancesco Porpiglia More articles by this author , and Giuseppe SimoneGiuseppe Simone More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003312.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urethral-sparing-RASP (usRASP) recently emerged as an innovative option for preserving antegrade ejaculation. To date, there is no clear recommendation for considering a robotic procedure as a standard treatment for large prostate glands. We aimed to compare perioperative and functional outcomes of usRASP vs standard RASP techniques on a large, multicentric dataset. METHODS: Two institutional BPH datasets (n=295) were matched and queried for “RASP” (Group A; n=83) and “usRASP” (Group B; n=94). Baseline, perioperative and functional data were compared between groups. Differences between continuous variables were assessed with Kruskal-Wallis test, while Pearson’s χ2 test was used for categorical data. RESULTS: Baseline and perioperative data were reported in Table 1. Compared to group B, patients treated with standard RASP were older (p=0.044), had lower preoperative PSA median values, prostate volume and episodes of urinary retention (all p<0.001), higher baseline median International Prostatic Symptoms Score (IPSS, p=0.015), lower median Sexual Health Invetory for Men (SHIM, p=0.012) and Insomnia Severity Index scores (ISI, p<0.001). In the group B, patients showed significantly higher median Male Sexual Health Questionnaire-Ejaculatory Dysfunction (MSHQ-EjD, p<0.001) and Quality fo Life scores (QoL, p=0.016). All other variables were comparable between groups (all p>0.05). With regard to perioperative outcomes, patients treated with usRASP revealed higher perioperative complications rates (Clavien>2, p=0.004), decreased median bladder irrigation time, longer median hospital stay and lower time to catheter removal (all p<0.001, Table 1). At a median follow-up of 41.5 months (IQR 31.6-54.5), usRASP showed higher post-operative post-void residual (PVR, 20 vs 5 ml) even if not clinically meaningful, significantly increased median MSHQ-EjD, lower ISI scores (all p<0.001), and increased QOL scores (p=0.027). CONCLUSIONS: Compared to standard RASP, usRASP showed non-inferior symptom relief, improved functional and sexual outcomes at long-term follow-up. However, to avoid unnecessary perioperative morbidity, current indications to usRASP remain limited to patients with large adenomas, sexually active and motivated to preserve ejaculatory function. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e808 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Prata Francesco More articles by this author Umberto Anceschi More articles by this author Daniele Amparore More articles by this author Andrea Iannuzzi More articles by this author Alberto Ragusa More articles by this author Alfredo Maria Bove More articles by this author Leonardo Misuraca More articles by this author Sabrina De Cillis More articles by this author Checcucci Enrico More articles by this author Aldo Brassetti More articles by this author Silvia Cartolano More articles by this author Ashanti Zampa More articles by this author Simone D'annunzio More articles by this author Riccardo Mastroianni More articles by this author Giuseppe Spadaro More articles by this author Gabriele Tuderti More articles by this author Mariaconsiglia Ferriero More articles by this author Salvatore Guaglianone More articles by this author Rocco Papalia More articles by this author Cristian Fiori More articles by this author Francesco Porpiglia More articles by this author Giuseppe Simone More articles by this author Expand All Advertisement PDF downloadLoading ...