MP25-17 ROBOTIC SIMPLE PROSTATECTOMY

Abstract

INTRODUCTION AND OBJECTIVE: Robot-assisted simple prostatectomy (RASP) is a surgical option for patients with symptomatic benign prostatic hyperplasia (BPH) for prostate size >80 grams. Although RASP has been increasingly utilized, it is unclear whether prostate size affects perioperative or functional outcomes. Herein, we compared perioperative and functional outcomes in patients with prostate size <150g vs. ≥150g. METHODS: A retrospective review of our robotic surgery database (5/2013-12/2018) identified patients who underwent RASP. All patients underwent Retzius-sparing approach with posterior cystotomy, excision of adenoma, and 360° urethrovesical anastomosis. Prostate volume was measured using US, CT, or MRI. Patients were stratified by prostate size (<150g and ≥150g). For functional outcomes, we used the total International Prostate Symptom Score (IPSS) with Quality of Life (QOL). Mann-Whitney U and Chi-Squared tests were utilized to compare the cohorts. RESULTS: Of the 146 patients with imaging studies available for analysis, 89 (60.9%) had glands <150g and 57 (39.1%) had glands ≥150g. At the time of analysis, our average length of follow-up was 18 (SD=19.5) months. We found no significant difference in console time, length of stay, 30-day post-operative complications (>Clavien Grade II) between the two cohorts. Estimated blood loss was significantly higher in glands ≥150g (200cc vs 275cc, p=0.008); yet, no patient required a blood transfusion in the larger gland cohort (Table 1). The median IPSS/QOL were significantly improved for both cohorts: 18 / 5 to 4 / 1 (p<0.00001) and 18 / 5 to 3 / 0 (p<0.00001), respectively. Comparison of post-operative IPSS/QOL between the 2 cohorts found no statistically significant difference: 4/1 vs. 3/0 (p=0.40 / p=0.23), respectively. Importantly, no patient reported new onset stress urinary incontinence or pad use. CONCLUSIONS: RASP is an effective surgical option for men with symptomatic BPH and large glands. Using the Retzius-sparing approach and complete urethrovesical anastomoses, we find that patients have similar peri-operative outcomes with significant reduction in lower urinary tract symptoms and no reported SUI regardless of prostate size at 18-month follow-up.Source of Funding: None