V08-10 MILLIN, FREYER AND MADIGAN ROBOT-ASSISTED SIMPLE PROSTATECTOMY: SURGICAL TECHNIQUE, PERIOPERATIVE AND 1 YR FUNTIONAL OUTCOMES

Abstract

You have accessJournal of UrologyBPH & Bladder Outlet Obstruction (V08)1 Apr 2020V08-10 MILLIN, FREYER AND MADIGAN ROBOT-ASSISTED SIMPLE PROSTATECTOMY: SURGICAL TECHNIQUE, PERIOPERATIVE AND 1 YR FUNTIONAL OUTCOMES Alfredo Bove*, Riccardo Mastroianni, Gabriele Tuderti, Umberto Anceschi, Aldo Brassetti, Mariaconsiglia Ferriero, and Giuseppe Simone Alfredo Bove*Alfredo Bove* More articles by this author , Riccardo MastroianniRiccardo Mastroianni More articles by this author , Gabriele TudertiGabriele Tuderti More articles by this author , Umberto AnceschiUmberto Anceschi More articles by this author , Aldo BrassettiAldo Brassetti More articles by this author , Mariaconsiglia FerrieroMariaconsiglia Ferriero More articles by this author , and Giuseppe SimoneGiuseppe Simone More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000909.010AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robot assisted simple prostatectomy (RASP) is an established surgical procedure for the management of obstructive symptoms caused by large adenomas. Traditionally this is performed according to the Freyer (trans-vescically) or Millin (trans-capsular) technique. These are known to cause retrograde ejaculation which limits their application in younger patients. We have recently described a novel urethra sparing (Madigan) technique which has shown some promising preliminary results. In this video we report our surgical technique and a retrospective comparison of perioperative and 1-yr functional outcomes between Freyer, Millin, and Madigan robot-assisted simple prostatectomy. METHODS: The video shows our surgical techniques for three different approaches of RASP: Freyer, Millin and Madigan. Standardized indications to the available techniques were: bladder diverticula or stones and/or large median lobe for Freyer technique, patients’ desire to preserve antegrade ejaculation in absence of any of the above mentioned criteria for Madigan procedure, Millin procedure in all other cases. Baseline and one-yr functional outcomes assessed by means of self-reported validated questionnaires (IPSS, IIEF, ICIQ short form, MSHQ Short Form) were analyzed. Categorical and continuous variables were compared with chi square and Student t test, respectively. RESULTS: Between June 2012 and September 2019, 45 patients underwent RASP: 23 (51%) Millin, 8 (18%) TVA, and 14 (31%) Madigan. The median follow-up was 37 months (18–63.5). Demographic and clinical data were homogeneous for BMI, prostate volume and ASA score (p=0.34, 0.23, 0.57 respectively), while patients who underwent Madigan were younger (median 66) compared to the Millin (72) and Freyer (74) cohorts (p=0.013). Baseline IPSS, IIEF, ICIQ, or MSHQ scores were comparable between groups (all p>0.17). Similarly, operative time, hospital stay and complication rates were comparable between groups (p=0.28, 0.27 and 0.32, respectively). The Madigan procedure provided higher 1-yr MSHQ score (median 10.5), mostly based on preserved antegrade ejaculation, compared with Millin (median 2) and Freyer (median 2) cohorts (p=0.04) and also a trend towards significantly higher IIEF score (p=0.05). CONCLUSIONS: Robot-assisted simple prostatectomy sounds a safe and feasible procedure. Freyer, Millin and Madigan techniques are comparable in terms of resolution of obstructive symptoms, regardless of the prostate size. Robotic Madigan simple prostatectomy has demonstrated a promising surgical approach to preserve ejaculatory function, ensuring resolution of obstructive symptoms, in particular for young patients strongly motivated to preserve antegrade ejaculation. Source of Funding: none © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e737-e738 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alfredo Bove* More articles by this author Riccardo Mastroianni More articles by this author Gabriele Tuderti More articles by this author Umberto Anceschi More articles by this author Aldo Brassetti More articles by this author Mariaconsiglia Ferriero More articles by this author Giuseppe Simone More articles by this author Expand All Advertisement PDF downloadLoading ...