Outcomes Of Robot-assisted Radical Prostatectomy Research Articles

"Single-Surgeon" versus "Dual-Surgeon" Robot-Assisted Radical Prostatectomy and Pelvic Lymph-nodes Dissection: Comparative Analysis of Perioperative Outcomes.

To compare the perioperative outcomes of robot-assisted radical prostatectomy (RARP) with pelvic lymph-nodes dissection (PLND) when the same surgeon performs RARP and PLND versus one surgeon performs RARP and another surgeon performs PLND. From January 2022 to March 2023, data of consecutive patients who underwent RARP with PLND were prospectively collected. The surgeries were performed by two "young" surgeons with detailed profile. Specifically for the study purpose, one surgeon performed RARP, and the other surgeon performed PLND. A set of surgeries performed according to the standard setup (i.e., the same surgeon performing both RARP and PLND) was retrieved from the institutional database and used as comparator arm. To test the study hypothesis, patients were divided into two groups: "dual-surgeon" versus "single-surgeon". Fifty patients underwent RARP and PLND performed according to dual-surgeon setup and were compared to the last 50 procedures performed according to the standard single-surgeon setup. Patients in the groups had comparable baseline characteristics. Dual-surgeon interventions had significantly shorter median total operative (194 [IQR 178-215] versus 174 [IQR 146-195] minutes, p<0.001) and console time (173 [IQR 158-194] versus 154 [IQR 129-170] minutes, p<0.001). No significant differences were found in terms of blood loss, intraoperative complications, postoperative outcomes, and final pathology results. The present analysis found that when RARP and PLND are split onto two surgeons, the operative time is shorter by 20 minutes compared to when a single surgeon performs RARP and PLND. This is an interesting finding that could sponsor further studies.

Robot-Assisted Radical Prostatectomy in Renal Transplant Recipients: A Systematic Review.

Robot-assisted radical prostatectomy (RARP) has been shown to achieve excellent oncological outcomes with a low rate of complications in patients with prostate cancer. However, data on RARP in renal transplant recipients (RT) are dispersed. A literature search was conducted through April 2023 using PubMed/Medline, Embase and Web of Science databases. The primary aim was to evaluate the safety, oncologic and clinical outcomes of RARP in RT recipients. The secondary aim was to identify surgical technique modifications required to avoid iatrogenic damage to the transplanted kidney. A total of 18 studies comprising 186 patients met the inclusion criteria. Age at the time of treatment ranged 43-79 years. Biopsy results showed a high prevalence of low- and intermediate-risk disease. Operative time ranged between 108.3 and 400 mins, while estimated blood loss ranged from 30 to 630 mL. Length of hospital stay ranged from 3 to 6 days whereas duration of catheterization was between 5 and 18 days. Perioperative complication rate was 17.1%. Overall positive surgical margin rate was 24.19%, while biochemical recurrence was observed in 10.21% (19/186 patients). Modifications to the standard surgical technique were described in 13/18 studies. Modifications in port placement were described in 7/13 studies and performed in 19/88 (21.6%) patients. Surgical technique for the development of the Retzius space was reported in 13/18 studies. Data on lymphadenectomy were reported in 15/18 studies. Bilateral lymphadenectomy was described in 3/18 studies and performed in 4/89 (4.5%) patients; contralateral lymphadenectomy was reported in 7/18 studies and performed in 41/125 (32.8%) patients. RARP in RTRs can be considered relatively safe and feasible. Oncological results yielded significantly worse outcomes in terms of PSM and BCR rate compared to the data available in the published studies, with an overall complication rate highly variable among the studies included. On the other hand, low graft damage during the procedure was observed. Main criticisms came from different tumor screening protocols and scarce information about lymphadenectomy techniques and outcomes among the included studies.

Partial gland ablation using high-intensity focused ultrasound versus robot-assisted radical prostatectomy: a propensity score-matched study.

We compared the clinical outcomes of robot-assisted radical prostatectomy (RARP) and partial gland ablation (PGA) using high-intensity focused ultrasound (HIFU) in localized prostate cancer. We analyzed 3,859 patients who had undergone RARP and PGA using HIFU. According to the propensity score for each treatment, 137 patients after PGA were matched to 3,722 patients after RARP at a 1:4 ratio using the nearest neighbor method. The matched cohort comprised 685 subjects (RARP, 548; PGA, 137), with a median follow-up period of 22months. Treatment failures were identified in 13.9% and 9.1% of patients in the PGA and RARP groups, respectively, after a median follow-up of 36months postoperatively. Kaplan-Meier analyses revealed significantly longer failure-free (P<0.001) and salvage-free survival (P=0.003) in the RARP group than in the PGA group. There was no significant difference in the postoperative urinary symptom score (P=0.748), but the postoperative erectile function score was significantly higher in the PGA group (P<0.001). The rate of urinary incontinence (any pad) was significantly lower in the PGA group than that in the RARP group (P<0.001). Postoperative complications were more frequent in the PGA group (P=0.003); however, there was no significant difference in high-grade complications (≥3) (P=0.467). PGA using HIFU showed statistically inferior oncological outcomes compared with RARP for failure-free survival and salvage-free survival. However, functional outcomes regarding postoperative incontinence and erectile dysfunction were more favorable in the PGA group.

Comparative analysis of 10-year functional outcomes of robot-assisted radical prostatectomy and radical retropubic prostatectomy. Experience of the Urology Clinic of the A.I. Evdokimov Moscow State University of Medicine and Dentistry

Background. Prostate cancer is the 3rd most common diagnosis among malignant tumors. The first robot-assisted radical prostatectomy (RARP) was performed in 2001. Studies comparing RARP and radical retropubic prostatectomy (RRP) are limited. In Russia, the Da Vinci robot was first installed in 2007. At the Urology Clinic of the A.I. Evdokimov Moscow State University of Medicine and Dentistry the program of robot-assisted surgery started in November of 2008.Aim. To perform first in Russia evaluation of 10-year functional treatment outcomes for patients with localized prostate cancer after RARP. To perform comparative analysis with RRP outcomes.Materials and methods. Medical histories of 211 patients from the Urology Clinic of the A.I. Evdokimov Moscow State University of Medicine and Dentistry were analyzed. Among them, 62 patients did not satisfy the inclusion criteria. Therefore, the study included 149 patients who underwent surgical treatment for localized prostate cancer between January of 2009 and December of 2011. Depending on the technique of surgical intervention, patients were divided into 2 groups: 1st – RARP (n = 82), 2nd – RRP (n = 67). All RARP were performed by a single surgeon, RRP by 2 experienced surgeons (experience &gt;1000 RRP).Results. Median follow-up was 120 months in both groups. Overall survival in the 1st and 2nd groups was 85.4 and 86.6 %, respectively (p &gt;0.05). For accuracy of functional outcomes analysis, patients who died during follow-up were excluded from the study. Frequency of neurovascular bundle preservation in the 1st and 2nd groups was 60.9 % (50/82) and 40.2 % (27/67), respectively (p = 0.01). Erectile function was preserved in 60.0 and 44.4 % males of the 1st and 2nd groups, respectively (p = 0.01). Age below 60 years (р = 0.009) and disease stage рТ2 (p = 0.026) were predictors of erectile function preservation after RARP. Continence frequency was 92.7 and 82.1 % in the 1st and 2nd groups, respectively (p = 0.048).Conclusion. Ten-year comparative analysis shows that RARP allows to achieve significantly better parameters of urinary continence and erectile function preservation in men with localized prostate cancer than RRP.

Comparative analysis of 10-year oncological outcomes of robot-assisted radical prostatectomy and radical retropubic prostatectomy. Experience of the Urology Clinic of the A.I. Evdokimov Moscow State University of Medicine and Dentistry

Background. Prostate cancer (PCa) is the 2nd most common oncological disease among men in the world. The first structured program of robot-assisted radical prostatectomy (RARP) was started in the year 2000. In the medical literature, a limited number of studies on long-term oncological treatment outcomes for patients with PCa after RARP is presented. In Russia, the Da Vinci robot was first installed in 2007. In the Urology Clinic of the A.I. Evdokimov Moscow State University of Medicine and Dentistry, the program of robot-assisted surgery was started in November of 2008.Aim. To perform first in Russia evaluation of 10-year oncological treatment outcomes for patients with localized PCa after RARP. To perform comparative analysis with the outcomes of radical retropubic prostatectomy (RRP).Materials and methods. Retrospective analysis of medical histories of 211 patients was performed. Among them, 62 patients did not satisfy the inclusion criteria. The remaining 149 patients were divided into 2 groups: 1st - RARP (n = 82), 2nd - RRP (n = 67). All RARP were performed by the same surgeon, RRP by 2 experienced surgeons.Results. Median follow-up was 110.35 ± 24.58 and 115.19 ± 15.37 months in the 1st and 2nd group, respectively; median follow-up was 120 months in both groups (p &gt;0.05). Survival was calculated using the Kaplan-Meyer approach. Ten-year biochemical recurrence (BCR)-free survival was 79.3 and 82.1 %, clinical recurrence-free survival was 96.3 and 97.1 %, metastasis-free survival was 92.7 and 94.0 %, cancer-specific survival was 93.9 and 95.6 % and overall survival was 85.4 and 86.6 % in the 1st and 2nd group, respectively. Mean time to BCR was 17.00 ± 20.67 and 22.83 ± 26.51 months, respectively ( p &gt;0.05). Calculation of BCR predictors was performed using correlation analysis based on contingency test and Cramer's V-test. In the 1st group, body mass index ≥30 kg/m2 (p = 0.01), prostate-specific antigen level &gt;10 ng/mL (p = 0.04), high progression risk per the D'Amico classification (p = 0.01) were independent preoperative predictors of BCR. Gleason score 7 (4 + 3) (p = 0.04) and ≥8 (p &lt;0.0001) per pathomorphological examination, pT3 stage, extraprostatic extension, invasion into the seminal vesicles and positive surgical margin (all p &lt;0.0001) were independent postoperative predictors of BCR.Conclusion. RARP demonstrates long-term (10-year) oncological effectiveness comparable to oncological effectiveness of RRP in patients with localized PCa.

Functional and oncological outcomes of robot-assisted radical prostatectomy in obese men: a matched-pair analysis.

Robot-assisted radical prostatectomy (RARP) in men with body mass index (BMI) ≥ 35kg/m2 is considered technically challenging. We conducted a retrospective matched-pair analysis to compare the oncological and functional outcomes of RARP in men with BMI ≥ 35kg/m2. We interrogated our prospectively maintained RARP database and identified 1273 men who underwent RARP from January 2018 till June 2021. Among them, 43 had BMI ≥ 35kg/m2, and 1230 had BMI < 35kg/m2. A 1:1 genetic matching was performed between these two groups for PSA, Gleason grades, clinical stage, D'Amico risk stratification, and nerve-spare extent. Continence rates and biochemical rates on 1-year follow-up were analysed. We performed statistical analysis using SPSS, and Paired tests were done using Wilcoxon sign rank-sum test. p < 0.05 was considered statistically significant. The two groups were comparable in almost all parameters except for age. Console time (p = 0.20) and estimated blood loss (p > 0.90) were not significantly different. There was no blood transfusion, open conversion or (Clavien-Dindo grade ≥ 3) intra/postoperative complication in either of the two groups. The two groups did not have any difference in biochemical recurrence rates (BCR) on 1-year follow-up (p > 0.90). Men with BMI ≥ 35 achieved continence rates equivalent to men with BMI < 35 within 1 year. On logistic regression analysis, age (p < 0.001) and extent of nerve sparing (p = 0.026) emerged as significant factors influencing continence recovery. RARP is safe in men with BMI ≥ 35kg/m2. The 1-year continence and oncological outcomes are similar to matched men with BMI < 35kg/m2 undergoing RARP.

Disparities in access to robotic technology and perioperative outcomes among patients treated with radical prostatectomy.

Most radical prostatectomies are completed with robotic assistance. While studies have previously evaluated perioperative outcomes of robot-assisted radical prostatectomy (RARP), this study investigates disparities in access and clinical outcomes of RARP. The National Cancer Database (NCDB) was used to identify patients who received radical prostatectomy for cancer between 2010 and 2017 with outcomes through 2018. RARP was compared to open radical prostatectomy (ORP). Odds of receiving RARP were evaluated while adjusting for covariates. Overall survival was evaluated using a propensity-score matched cohort. Overall, 354 752 patients were included with 297 676 (83.9%) receiving RARP. Patients who were non-Hispanic Black (82.8%) or Hispanic (81.3%) had lower rates of RARP than non-Hispanic White (84.0%) or Asian patients (87.7%, p < 0.001). Medicaid or uninsured patients were less likely to receive RARP (75.5%) compared to patients with Medicare or private insurance (84.4%, p < 0.001). Medicaid or uninsured status was associated with decreased odds of RARP in adjusted multivariable analysis (OR 0.61, 95% CI 0.49-0.76). RARP was associated with decreased perioperative mortality and improved overall survival compared to ORP. Patients who were underinsured were less likely to receive RARP. Improved access to RARP may lead to decreased disparities in perioperative outcomes for prostate cancer.

MP55-04 THE PREOPERATIVE USE OF MICROUS TO DETECT EXTRAPROSTATIC EXTENSION OF PROSTATE CANCER: AN UPDATE OF A SINGLE INSTITUTIONAL PROSPECTIVE SERIES

You have accessJournal of UrologyCME1 Apr 2023MP55-04 THE PREOPERATIVE USE OF MICROUS TO DETECT EXTRAPROSTATIC EXTENSION OF PROSTATE CANCER: AN UPDATE OF A SINGLE INSTITUTIONAL PROSPECTIVE SERIES Vittorio Fasulo, Fabio De Carne, Edoardo Beatrici, Luca Disconzi, Nicola Frego, Pier Paolo Avolio, Marco Paciotti, Andrea Gobbo, Pietro Diana, Alessandro Uleri, Davide Maffei, Giuseppe Chiarelli, Paola Arena, Giuseppe Garofano, Alberto Saita, Rodolfo Hurle, Massimo Lazzeri, Nicolò Maria Buffi, Paolo Casale, and Giovanni Lughezzani Vittorio FasuloVittorio Fasulo More articles by this author , Fabio De CarneFabio De Carne More articles by this author , Edoardo BeatriciEdoardo Beatrici More articles by this author , Luca DisconziLuca Disconzi More articles by this author , Nicola FregoNicola Frego More articles by this author , Pier Paolo AvolioPier Paolo Avolio More articles by this author , Marco PaciottiMarco Paciotti More articles by this author , Andrea GobboAndrea Gobbo More articles by this author , Pietro DianaPietro Diana More articles by this author , Alessandro UleriAlessandro Uleri More articles by this author , Davide MaffeiDavide Maffei More articles by this author , Giuseppe ChiarelliGiuseppe Chiarelli More articles by this author , Paola ArenaPaola Arena More articles by this author , Giuseppe GarofanoGiuseppe Garofano More articles by this author , Alberto SaitaAlberto Saita More articles by this author , Rodolfo HurleRodolfo Hurle More articles by this author , Massimo LazzeriMassimo Lazzeri More articles by this author , Nicolò Maria BuffiNicolò Maria Buffi More articles by this author , Paolo CasalePaolo Casale More articles by this author , and Giovanni LughezzaniGiovanni Lughezzani More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003308.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Stratification of patients with localized prostate cancer (PCa) before robotic assisted radical prostatectomy (RARP) allows performing a tailor-made surgery, potentially providing a nerve-sparing procedure even in those patients with high-risk disease. Nowadays the accuracy of clinical parameters to determine extraprostatic extension (EPE) is moderate, so a new imaging tool capable of providing a more accurate assessment is in order. Our goal is to evaluate the added value of microUS in the preoperative prediction of EPE. METHODS: Our prospective single-institutional cohort study enrolled patients with diagnosis of PCa scheduled for RARP. We included patients with PSA<20 ng/mL, prostate volume<100 mL and a preoperative microUS investigation. MRI-derived features (curvilinear contact length [CCL], capsular bulging, visible extracapsular extension [ECE]), along with microUS features (such as the presence of hypoechoic halo and obliteration of the vesicle-prostatic angle) were tested as predictors of EPE. Multivariable logistic regression models were fitted to test the accuracy of clinical parameters (total PSA, ISUP biopsy and digital rectal examination [DRE]) plus microUS parameters for EPE prediction. RESULTS: Overall, 230 patients were recruited. All predictors were associated with non-organconfined disease (p<0.001). Histological findings showed that 131 (56.9%) and 99 (43.0%) had respectively a pT2 and a pT3 or greater disease. Individuals with only 1 predictor had a rate of non-organconfined PCa of 16.7% (OR 3.12), compared to 93.8% in those where 4 predictors were simultaneously observed (OR 75.0). At MLRM, the most significant risk factors for EPE were visible ECE (OR 3.23; p<0.004), positive DRE (OR 2.5;p=0.015), and PSA (OR 1.06; p=0.03). The AUC increased from 0.809 to 0.841 when considering the clinical model alone and the model including both clinical and microUS features respectively (Figure 1). The DeLong test for equality showed a significant difference between the two curves (p=0.04). CONCLUSIONS: Our results confirm that microUS may represent an accurate tool for the evaluation of non-organ confined PCa. Future studies should externally validate our findings and determine the impact of microUS in the outcomes of RARP. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e764 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Vittorio Fasulo More articles by this author Fabio De Carne More articles by this author Edoardo Beatrici More articles by this author Luca Disconzi More articles by this author Nicola Frego More articles by this author Pier Paolo Avolio More articles by this author Marco Paciotti More articles by this author Andrea Gobbo More articles by this author Pietro Diana More articles by this author Alessandro Uleri More articles by this author Davide Maffei More articles by this author Giuseppe Chiarelli More articles by this author Paola Arena More articles by this author Giuseppe Garofano More articles by this author Alberto Saita More articles by this author Rodolfo Hurle More articles by this author Massimo Lazzeri More articles by this author Nicolò Maria Buffi More articles by this author Paolo Casale More articles by this author Giovanni Lughezzani More articles by this author Expand All Advertisement PDF downloadLoading ...

Perioperative, functional, and oncologic outcomes in patients undergoing robot-assisted radical prostatectomy previous transurethral resection of prostate: a systematic review and meta-analysis of comparative trials.

The influence of robot-assisted radical prostatectomy (RARP) on patients who have previously undergone transurethral resection of the prostate (TURP) versus TURP-naive patients is still debatable. The present study aimed to compare perioperative, functional, and oncologic outcomes of RARP between TURP and Non-TURP groups. We systematically searched the databases such as Science, PubMed, Embase, Web of Science, and the Cochrane Library database to identify relevant studies published in English up to August 2022. Review Manager was used to compare various parameters. The study was registered with PROSPERO (CRD42022378126). Eight comparative trials with a total of 4186 participants were conducted. The TURP group had a longer operative time (WMD 22.22min, 95% CI 8.48, 35.95; p = 0.002), a longer catheterization time (WMD 1.32day, 95% CI 0.37, 2.26; p = 0.006), a higher estimated blood loss (WMD 23.86mL, 95% CI 2.81, 44.90; p = 0.03), and higher bladder neck reconstruction rate (OR 8.02, 95% CI 3.07, 20.93; p < 0.0001). Moreover, the positive surgical margin (PSM) was higher in the TURP group (OR 1.49, 95% CI 1.12, 1.98 p = 0.007). However, there was no difference between the two groups regarding the length of hospital stay, transfusion rates, nerve-sparing status, complication rates, long-term continence, potency rates and biochemical recurrence (BCR). Performing RARP on patients who have previously undergone TURP is a safe procedure. Furthermore, the current findings demonstrated that the TURP group had comparable oncologic and long-term functional outcomes to the Non-TURP group.

The Availability, Cost, Limitations, Learning Curve and Future of Robotic Systems in Urology and Prostate Cancer Surgery

Robot-assisted surgical systems (RASS) have revolutionised the management of many urological conditions over the last two decades with robot-assisted radical prostatectomy (RARP) now being considered by many to be the preferred surgical approach. Intuitive Surgical has dominated the market during this time period with successive iterations of the da Vinci model. The expiration of patents has opened the RASS market and several new contenders have become available or are currently in development. This comprehensive narrative review aims to explore the merits of each robotic system as well as the evidence and barriers to their use. The newly developed RASS have increased the versality of robotic surgical systems to a wider range of settings through advancement in technology. The increased competition may result in an overall reduction in cost, broadening the accessibility of RASS. Learning curves and training remain a barrier to their use, but the situation appears to be improving through dedicated training programmes. Outcomes for RARP have been well investigated and tend to support improved early functional outcomes. Overall, the rapid developments in the field of robot-assisted surgery indicate the beginning of a promising new era to further enhance urological surgery.

Oncological and functional outcomes of high-risk and very high-risk prostate cancer patients after robot-assisted radical prostatectomy.

This study investigated the oncological and functional outcomes of robot-assisted radical prostatectomy (RaRP) in high-risk and very high-risk prostate cancer patients. One hundred localized prostate cancer patients receiving RaRP from August 2015 to December 2020 were retrospectively enrolled. According to NCCN risk classification, patients were classified into two groups, below high-risk group, and high-risk/very high-risk group, to analyze continence outcome within postoperative year one and biochemical recurrence-free survival. The mean age of the cohort was 69.7 ± 7.4 years with a median follow-up of 26.4 (range 3.3-71.3) months. Among them, 53%, and 47% patients were below high-risk group, and high-risk/very high-risk group, respectively. The median biochemical recurrence-free survival of the entire cohort was 53.1 months. The high-risk/very high-risk group without adjuvant treatment had significantly worse biochemical recurrence-free survival than the high-risk/very high-risk group with adjuvant treatment (19.6 vs. 60.5 months, p = 0.029). Rates of postoperative stress urinary incontinence at 1 week, 1 month, and 12 months were 50.7%, 43.7%, and 8.5%, respectively. High-risk/very high-risk patients had significantly higher rates of stress urinary incontinence at postoperative week 1 (75.8% vs. 28.9%) and month 1 (63.6% vs. 26.3%) than the below high-risk group (both p < 0.01). Rates of stress urinary incontinence after RaRP did not differ between two groups from postoperative 3 months to 12 months. The factor of high-risk / very high-risk group was a predictor of immediate but not for long-term postoperative stress urinary incontinence. High-risk and very high-risk prostate cancer patients receiving a combination of RaRP and adjuvant treatment had comparable biochemical recurrence-free survival to below high-risk prostate cancer patients. The high-risk/very high-risk factor impeded early but not long-term postoperative recovery of continence. RaRP can be considered a safe and feasible option for high-risk and very high-risk prostate cancer patients.

Impacts on functional and oncological outcomes of robotic-assisted radical prostatectomy 10 years after the taskforce recommendations against PSA screening

Impacts on functional and oncological outcomes of robotic-assisted radical prostatectomy 10 years after the taskforce recommendations against PSA screening

Surgical outcomes of robot-assisted radical prostatectomy with the novel HUGO™ robotic system: Initial 100 cases performed at a tertiary referral robotic center

Surgical outcomes of robot-assisted radical prostatectomy with the novel HUGO™ robotic system: Initial 100 cases performed at a tertiary referral robotic center

Outcomes of Robot-assisted Radical Prostatectomy with the Hugo RAS Surgical System: Initial Experience at a High-volume Robotic Center

Clinical data on robot-assisted radical prostatectomy (RARP) performed with the new Hugo robot-assisted surgery (RAS) system are scarce. We described surgical outcomes of 112 consecutive patients who underwent RARP ± extended pelvic lymph-node dissection (ePLND) at OLV Hospital (Aalst, Belgium) between February and November 2022. The median age was 65 yr (interquartile range [IQR] 60–70) and median preoperative prostate-specific antigen (PSA) was 7.9 ng/ml (5.8–10.7). Thirty-eight patients (34%) had International Society of Urological Pathology grade group ≥3 tumor on prostate biopsy. On preoperative magnetic resonance imaging, 26 (23%) patients had a suspicion of extraprostatic disease. The median operative time was 180 min (IQR 145–200) and 27 men (24%) underwent ePLND. On final pathology, 34 patients (31%) had extraprostatic disease and ten (9%) had positive surgical margins. The median number of nodes removed was 15 (IQR 9–19). Among men with data available on the first PSA after surgery, 88% (60/68) had undetectable PSA (<0.1 ng/ml). The probability of urinary continence (UC) recovery was 36% (95% confidence interval [CI] 28–47%) at 1 mo and 81% (95% CI 72–89%) at 3 mo. The median time to UC recovery was 36 d (95% CI 34–44). This is the first report of data on UC recovery and surgical pathology for patients undergoing RARP for prostate cancer performed with the Hugo RAS robotic system. Future investigations with longer follow-up are awaited. Patient summaryWe describe surgical outcomes of patients undergoing robot-assisted surgical removal of the prostate for cancer performed with the Hugo RAS robotic system at our institution. In our experience this platform provided adequate results in terms of surgical results and early recovery of urinary continence. Studies with longer follow-up are awaited.

Comparison of therapeutic features and oncologic outcome in patients with pN1 prostate cancer among robot-assisted, laparoscopic, or open radical prostatectomy.

To compare the therapeutic features and oncological outcomes of robot-assisted radical prostatectomy (RARP) with those of open radical prostatectomy (ORP) or laparoscopic radical prostatectomy (LRP) in lymph node (LN) positive prostate cancer patients in a retrospective observational multi-institutional study. We evaluated the clinical results of 561 patients across 33 institutions who underwent RARP, LRP, or ORP and who were diagnosed with LN-positive prostate cancer during RP with pelvic LN dissection (PLND). We determined the following survival outcomes: metastasis-free survival, overall survival, cancer-specific survival, and biochemical recurrence-free survival. The Kaplan-Meier method, log-rank test, and Cox proportional hazards regression model were used to evaluate the effect of treatment on oncological outcomes. Statistical significance was set atP < 0.05. There was no significant difference for any of the survival outcomes between the three surgical groups. However, RARP achieved a greater LN yield compared to that of ORP or LRP. When the extent of PLND was limited to the obturator LNs, the number of removed LNs (RLNs) was comparable between the three surgical groups. However, higher numbers of RLNs were achieved with RARP compared to the number of RLNs with ORP (P < 0.001) when PLND was extended to the external and/or internal iliac LNs. RARP, LRP, and ORP provided equal surgical outcomes for pN1 prostate cancer, and the prognosis was relatively good for all procedures. Increased numbers of RLNs may not necessarily affect the oncological outcome.

SC230 - Assessing the detrimental effect of the covid-19 pandemic on the outcomes of robot-assisted radical prostatectomy. A single-institutional analysis

SC230 - Assessing the detrimental effect of the covid-19 pandemic on the outcomes of robot-assisted radical prostatectomy. A single-institutional analysis

SC198 - Surgical setting and perioperative outcomes of robot-assisted radical prostatectomy with the novel “hugo” robotic system: initial experience at a tertiary referral robotic center

SC198 - Surgical setting and perioperative outcomes of robot-assisted radical prostatectomy with the novel “hugo” robotic system: initial experience at a tertiary referral robotic center

MP51-12 THE ADDED VALUE OF MICROUS FOR THE PREOPERATIVE STAGING OF PROSTATE CANCER: AN UPDATE OF A SINGLE-INSTITUTIONAL PROSPECTIVE SERIES

You have accessJournal of UrologyCME1 May 2022MP51-12 THE ADDED VALUE OF MICROUS FOR THE PREOPERATIVE STAGING OF PROSTATE CANCER: AN UPDATE OF A SINGLE-INSTITUTIONAL PROSPECTIVE SERIES Vittorio Fasulo, Edoardo Beatrici, Luca Disconzi, Pier Paolo Avolio, Nicola Frego, Pietro Diana, Marco Paciotti, Davide Maffei, Alessandro Uleri, Cesare Saitta, Paola Arena, Giuseppe Chiarelli, Andrea Gobbo, Alberto Saita, Rodolfo Hurle, Massimo Lazzeri, Giorgio Guazzoni, Paolo Casale, Nicolò Maria Buffi, and Giovanni Lughezzani Vittorio FasuloVittorio Fasulo More articles by this author , Edoardo BeatriciEdoardo Beatrici More articles by this author , Luca DisconziLuca Disconzi More articles by this author , Pier Paolo AvolioPier Paolo Avolio More articles by this author , Nicola FregoNicola Frego More articles by this author , Pietro DianaPietro Diana More articles by this author , Marco PaciottiMarco Paciotti More articles by this author , Davide MaffeiDavide Maffei More articles by this author , Alessandro UleriAlessandro Uleri More articles by this author , Cesare SaittaCesare Saitta More articles by this author , Paola ArenaPaola Arena More articles by this author , Giuseppe ChiarelliGiuseppe Chiarelli More articles by this author , Andrea GobboAndrea Gobbo More articles by this author , Alberto SaitaAlberto Saita More articles by this author , Rodolfo HurleRodolfo Hurle More articles by this author , Massimo LazzeriMassimo Lazzeri More articles by this author , Giorgio GuazzoniGiorgio Guazzoni More articles by this author , Paolo CasalePaolo Casale More articles by this author , Nicolò Maria BuffiNicolò Maria Buffi More articles by this author , and Giovanni LughezzaniGiovanni Lughezzani More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002626.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A stratification of patients with prostate cancer (PCa) before robotic-assisted radical prostatectomy (RARP) allows performing a tailor-made surgery, providing a nerve-sparing procedure even in those patients with high-risk PCa. Since the accuracy of clinical parameters to determine extraprostatic extension (EPE) is moderate, there is urgent need for imaging tools capable of providing a more accurate assessment. Our goal is to evaluate the added value of microUS in the preoperative prediction of EPE. METHODS: This is a prospective single-institutional cohort study enrolling patients with biopsy-proven PCa scheduled for RARP. Patients with PSA>20ng/mL and prostate volume>100 mL were excluded. All patients underwent microUS prior to RARP. MRI-derived features (curvilinear contact length (CCL), capsular bulging, visible extracapsular extension (ECE), as well as microUS features such as the presence of hypoechoic halo and obliteration of the vesicle-prostatic angle) were tested as predictors of EPE. Multivariable logistic regression models were fitted to test the accuracy of clinical parameters (total PSA, ISUP biopsy and digital rectal examination [DRE]) plus microUS parameters for the prediction of EPE. RESULTS: Overall, 184 patients were prospectively recruited. Besides CCL, all predictors were associated with non-organ- confined disease (p<0.001). Final pathology showed that 57.1% and 42.9% had respectively a pT2 and a pT3 or greater disease. The rate of non-organ-confined disease increased from 37.1%, in those individuals with only 1 predictor (OR 2.68), to 93.3% in those where 4 predictors were simultaneously observed (OR 63.5). At MLRM, the most significant risk factors for EPE were visible ECE (OR 5.21), positive DRE (OR 3.49), capsular bulge (OR 2.45), and PSA (OR 1.06). The clinical model alone showed an AUC of 0.804 as compared to 0.84 for the model including both clinical and microUS parameters (Figure1). The DeLong test for equality showed a difference between the two curves (p=0.0470). CONCLUSIONS: Our findings suggest that microUS may represent an accurate tool for the evaluation of non-organ confined PCa. Future studies should externally validate our findings and determine the impact of this tool in the surgical and oncological outcomes of RARP. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e880 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Vittorio Fasulo More articles by this author Edoardo Beatrici More articles by this author Luca Disconzi More articles by this author Pier Paolo Avolio More articles by this author Nicola Frego More articles by this author Pietro Diana More articles by this author Marco Paciotti More articles by this author Davide Maffei More articles by this author Alessandro Uleri More articles by this author Cesare Saitta More articles by this author Paola Arena More articles by this author Giuseppe Chiarelli More articles by this author Andrea Gobbo More articles by this author Alberto Saita More articles by this author Rodolfo Hurle More articles by this author Massimo Lazzeri More articles by this author Giorgio Guazzoni More articles by this author Paolo Casale More articles by this author Nicolò Maria Buffi More articles by this author Giovanni Lughezzani More articles by this author Expand All Advertisement PDF DownloadLoading ...

The association between perineural invasion in mpMRI-targeted and/or systematic prostate biopsy and adverse pathological outcomes in robot-assisted radical prostatectomy

Introduction and objectivesThis study aims to investigate the relationship between perineural invasion (PNI) in targeted (TBx) and/or systematic (SBx) prostate needle biopsy and adverse pathological features of prostate cancer (PCa) in prostatectomy specimens. Materials and methodsA total of 95 male patients who underwent transperineal TBx and/or concomitant SBx subsequently treated with robot-assisted radical prostatectomy for PCa between October 2015 and June 2020 were included. The performance of PNI as a classification test (sensitivity, specificity, positive and negative predictive values) and its correlation with clinically significant PCa, surgical margin positivity, extraprostatic extension, and seminal vesicle invasion in prostatectomy were computed. ResultsThe median age of the patients was 65 (60-70) years. TBx and concomitant SBx were performed in 78 (82.1%) patients, while 16 (16.8%) patients underwent SBx alone and one (1.1%) patient underwent TBx alone. The frequency of PNI in TBx and SBx was 17 (21.5%) and 32 (34.0%), respectively. The specificity/negative predictive values of PNI for surgical margin positivity, extraprostatic extension, and seminal vesicle invasion were 79.7/88.7%, 92.5/79.0%, and 83.3/96.8%, in TBx, and 71.1/87.1%, 80.7/74.2%, and 69.5/91.9%, in SBx, respectively. There was also a statistically significant correlation between PNI in biopsy and surgical margin positivity, extraprostatic extension, and seminal vesicle invasion in prostatectomy as well as the ISUP grade group and pT stage. ConclusionsThe absence of PNI in prostate needle biopsy may predict localized PCa with a pT stage ≤ 2c and negative surgical margins in contrast to its presence which appears to be an indicator of unfavorable factors in final pathology.

Comparison of surgical approaches to radical prostatectomy in our series beyond oncological and functional outcomes

ObjectivesTo evaluate the outcomes of robot-assisted radical prostatectomy (RARP) compared to those of open (ORP) and laparoscopic (LRP) surgery. The interest lies fundamentally in the quality-of-life (QoL) evaluation, postoperative recovery, and personal satisfaction of patients with the intervention (PS) beyond oncological and functional outcomes. MethodsSix hundred eighty-five RPs were performed in our center between 2011–2018 (17,8% ORP, 22,2% LRP and 60% RARP). Patients were prospectively assessed through follow-up until April 2020 and a multiple questionnaire at 12-months post-RP that included ICIQ-SF, SHIM, IPSS, IQL and questions about pain, postoperative recovery and PS. Also baseline and postoperative patient- and treatment-related data were collected, and binomial logistic regressions were performed for the 1 vs.1 comparisons (ORP vs. RARP and LRP vs. RARP). ResultsRARP patients have overall fewer comorbidities, less tumor aggressiveness, more operative time requirements and more positive surgical margins than ORP and LRP patients. Nevertheless, RARP outperforms ORP in: hospital stay (days) (OR 0,86; 95% CI: 0,80–0,94), hemoglobin loss (OR 0,38; 95% CI: 0,30–0,47), transfusion rate (OR 0,18; 95% CI: 0,09–0,34), early complications (p = 0,001), IQL (OR 0,82; 95% CI: 0,69–0,98), erectile function (OR 0,41; 95% CI: 0,21–0,79), pain control (OR 0,82; 95% CI: 0,75–0,89), postoperative recovery (p < 0,001) and choice of a different approach (OR 5,55; 95% CI: 3,14–9,80). RARP is superior to LRP in: urinary continence (OR 0,55; 95% CI: 0,37–0,82), IPSS (OR 0,96; 95% CI: 0,93–0,98), IQL (OR 0,76; 95% CI: 0,66–0,88), erectile function (OR 0,52; 95% CI: 0,29–0,93), postoperative recovery (p = 0,02 and 0,004), PS (p = 0,005; 0,002; and 0,03) and choice of a different approach (OR 7,79; 95% CI: 4,63–13,13). ConclusionsThe findings of our study globally endorse a positive effectiveness of RARP over ORP and/or LRP, both on functional issues, postoperative recovery, QoL and PS. Oncologic results should still be improved.