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

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 129 ml (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 (Q(max)) was 7 ml/s (IQR 5-11), and the median post-void residual volume (PVRV) was 73 ml (IQR 40-116). The median operative time was 97 min (IQR 80-127) and the median estimated blood loss was 200 ml (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 23 ml/s (IQR 16-35), and the median PVRV was 0 ml (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.