Urethral-Sparing Robot-Assisted Simple Prostatectomy: Case Series of the Initial Experience of a Brazilian Surgical Center

Abstract

Benign prostatic hyperplasia (BPH) is a common condition among older men that causes lower urinary tract symptoms. Although pharmacological treatments are available, surgery is often required. The development of surgical techniques has progressed, with robotic simple prostatectomy (RASP) being one of the minimally invasive techniques for larger prostates. However, ejaculatory dysfunction remains a common postoperative problem of BPH surgery, significantly impacting patients' quality of life. In 1990, Dixon et al. were the first to describe the urethral-sparing approach, which maintained anterograde ejaculation. Recently, Wang et al. performed the first urethral-sparing RASP (USRASP). We present a case series from the initial experience of US-RASP in a high-volume Brazilian surgical center with an experienced robotic surgeon. Three patients underwent US-RASP at our center in 2022 were included. The mean age and prostate volume were, respectively, 67.7 years (42-89) and 88.9ml (85.6-92). None of the patients had a median lobe. Total preservation of the urethra was achieved in all patients, with no US-RASP failures and conversion to standard RASP. The average operative time of US-RASP was 98min (86-118). There were no intraoperative complications. Two of the three patients maintained anterograde ejaculation (66.7%), but with reduced volume. There were no postoperative complications and the patients are still being followed up to assess the long-term results. Therefore, our results suggest that USRASP can be implemented with good rates of preservation of the urethra and anterograde ejaculation, since performed by an experienced robotic surgeon.