Robot-assisted Radical Prostatectomy Group Research Articles

The impact of surgical technique on very early functional outcomes after radical prostatectomy.

To determine the very early functional as well as oncological outcomes after robot-assisted radical prostatectomy (RARP) and open radical prostatectomy (ORP) at a single institution. We identified patients who underwent RARP or ORP at our institution between August 2021 and July 2023. The main criterion for surgical technique selection was patient preference. Primary endpoints included anastomosis leakage rate, very early continence rate reported by standardized pad-test, and positive surgical margin rate. Furthermore, we analyzed operation time, hospital stay, postoperative analgesia, and complication rates. In this prospective study, we analyzed data from 222 radical prostatectomies (111 RARP and 111 ORP). There were no significant differences in preoperative age, prostate size, and risk stratification among the groups. Patients who underwent RARP had lower anastomosis leakage rates (8.1% vs. 18.9%) and slightly lower early continence rates (76.6% vs. 78.4%) when compared to patients who underwent ORP. Positive surgical margin rates were similar, and complication rates were also comparable. Operation time was similar for both techniques, but the hospital stay was significantly shorter in the RARP group (6.3 vs. 9.1 days, p=0.03). The ORP group experienced significantly higher opioid administration postoperatively (p<0.001). From a functional and oncological point of view, both techniques are safe and provide excellent outcomes when performed by experienced surgeons. Nevertheless, patients are likely to benefit from a shortened hospital stay and reduced postoperative pain after RARP.

Win ratio analysis of short-term clinical outcomes of focal therapy and robot-assisted radical prostatectomy for the patients with localized prostate cancer

We compared the comprehensive clinical outcomes of focal therapy (FT) and robot-assisted radical prostatectomy (RARP) in patients with localized prostate cancer (PC) using a win ratio analysis. After propensity score matching, a win ratio analysis, in which the composite endpoints of failure-free survival (FFS) and the urinary domain of the Expanded Prostate Cancer Index Composite (EPIC) were analyzed, was used for the comparison of the clinical outcomes of FT and RARP for the patients with localized PC. Seventy-two patients were included in each group after propensity score matching. FFS was not significantly different between the groups (p = 0.5044) after 36 months of follow-up. In contrast, the score of the urinary domain of the EPIC in the FT group was significantly better than that in the RARP group (p < 0.0001). The win ratio of FT per RARP was 3.39 (p < 0.0001; 95% confidence interval 2.21–5.20), suggesting a higher comprehensive outcome in the FT group than in the RARP group during short-term follow-up in single institution. Although further randomized trial with long-term follow-up would be needed for the evaluation, the win ratio would be useful to analyze the efficacy of FT according to patient preferences comprehensively.

Surgical technique for preventing lymphatic complications during robot-assisted radical prostatectomy

Introduction. Radical prostatectomy (RP) stands the gold standard method of treatment for localised prostate cancer. Pelvic lymph node dissection (PLND) is a common surgical procedure that can be used for both diagnostic and therapeutic purposes. Lymphocele is the most common complication after robot-assisted radical prostatectomy (RARP) and PLND.Objective. To develop a surgical technique aimed at reducing the incidence of lymphocele in patients who underwent RARP with TL and to evaluate its efficacy and safety.Materials &amp; methods. The study included 49 patients who underwent RARP and PLND. The patients were divided into 2 groups: group 1 — patients with free peritoneal flap fixed to the pubic bone after RARP and PLND (n = 25) and group 2 — control group «without peritoneal flap fixation» (n = 24). The average follow-up period was 3 months.Results. No significant differences in clinical parameters were observed between the groups in perioperative period. In postoperative period lymphocele was diagnosed in 5 (10.2%) patients: group 1 — 1 (4%) patients, group 2 — 4 (16.7%). There were no significant differences in lymphocele volume between the groups. In group 1 lymphocele had no clinical manifestation. Symptomatic lymphocele was diagnosed in 1 patient (4.2%) from the control group.Conclusion. The surgical technique of a free peritoneal flap fixation to the pubic bone combined with PLND after RARP may reduce the incidence of lymphocele if compared to the standard technique.

Ten-year functional and oncological outcomes of a prospective randomized controlled trial comparing laparoscopic versus robot-assisted radical prostatectomy.

Among prostate cancer (PCa) treatment options, mini-invasive surgical approaches have gained a wide diffusion in the last decades. The aim of this study was to present oncological, functional, and quality of life data after 10 years of follow-up of a prospective randomized controlled trial (RCT) (ISRCTN11552140) comparing robot-assisted radical prostatectomy (RARP) versus laparoscopic radical prostatectomy (LRP) for the treatment of PCa. Patients with localized PCa were randomized to undergo LRP or RARP between January 2010 and January 2011. Functional (continence and potency) and oncological (prostate-specific antigen, biochemical recurrence [BCR] and BCR-free survival [BCRFS]) variables were evaluated. BCRFS curves were estimated by the Kaplan-Meier method and compared using the log-rank test. Machine learning partial least square-discriminant analysis (PLS-DA) was used to identify the variables characterizing more the patients who underwent RARP or LRP. Seventy-five of the originally enrolled 120 patients remained on follow-up for 10 years; 40 (53%) underwent RARP and 35 (47%) LRP. Continence and potency recovery rates did not show significant differences (p = 0.068 and p = 0.56, respectively), despite a Δ12% for continence and Δ8% for potency in favor of the robotic approach. However, the quality of continence (in terms of International Consultation on Incontinence Questionnaire-Short Form [ICIQ-SF] score) and erection (in terms of International Index of Erectile Function-5 [IIEF-5] score) was significantly better after 10 years in the robotic group (p = 0.02 and p < 0.001). PLS-DA revealed that LRP was characterized by the worst functional-related outcomes analyzing the entire follow-up period. Four (10%) and six (17%) patients experienced BCR in RARP and LRP groups, respectively (p = 0.36), with an overall 10-year BCR-free survival of 88% and 78% (p = 0.16). Comparable continence and potency rates were observed between RARP and LRP after a 10-year follow-up. However, the RARP group exhibited superior totally dry rate and erection quality. No difference in terms of oncological outcomes was found.

Comparison of sexual function after robot-assisted radical prostatectomy and carbon-ion radiotherapy for Japanese prostate cancer patients using propensity score matching

BackgroundThe quality of life of patients is an important consideration when selecting treatments for localized prostate cancer (PCa). We retrospectively compared sexual function after robot-assisted radical prostatectomy (RARP) and carbon-ion radiotherapy (CIRT) using propensity score matching.MethodsIn total, 127 Japanese PCa patients treated with RARP and 190 treated with CIRT monotherapy were evaluated. We evaluated the Expanded Prostate Cancer Index Composite (EPIC) score before treatment and 12 and 24 months after treatment. After propensity score matching, data from 101 patients from each group were analyzed. The study protocol was approved by the Institutional Review Board of Gunma University Hospital (no. IRB2020-050, 1839).ResultsAfter propensity score matching, the mean EPIC sexual function summary scores in the RARP and CIRT groups were 46.4 and 48.2, respectively. At 12 and 24 months after treatment, these scores were 27.9 (39.9% decrease) and 28.2 (39.2% decrease) in the RARP group and 41.4 (14.1% decrease) and 41.6 (13.7% decrease) in the CIRT group, respectively. Both groups demonstrated significantly decreased scores after 12 and 24 months of treatment compared to before treatment (all p < 0.05). At 12 and 24 months, the sexual function summary score was significantly higher in the CIRT group than in the RARP group (p < 0.001).ConclusionsThere was a smaller decrease in the EPIC sexual function score in the CIRT group than in the RARP group. These results provide useful information for treatment decision-making of Japanese PCa patients.

Transperitoneal Versus Extraperitoneal Approach for Laparoscopic and Robot-Assisted Radical Prostatectomy: A Systematic Review and Meta-Analysis.

To conduct a comparative analysis of outcomes from 2 different surgical approaches, transperitoneal radical prostatectomy (TP-RP) and extraperitoneal radical prostatectomy (EP-RP) in minimally invasive surgery. A comprehensive search was conducted up to September 2022 using 5 online databases, namely PubMed, Cochrane, Scopus, EMBASE, and Science Direct. Studies were screened per the eligibility criteria, and outcomes included operative duration, estimated blood loss (EBL), hospital stay, operative complication, and positive surgical margin. Total of 13 studies compiled of 2387 patients were selected, with TP-RP and EP-RP performed on 1117 (46.79%) and 1270 (53.21%) patients, respectively. Six laparoscopy radical prostatectomy (LRP) studies and 7 robotassisted radical prostatectomy (RARP) studies with 1140 and 1247 patients, respectively, were also included. The EP-RP demonstrated a marked advantage in terms of operative complications (Risk Ratio [RR]=0.78, 95% CI=0.62, 0.98; P=.04), but no significant difference concluded for operative duration, EBL, hospital stay, and surgical margin. In the RARP group, there was a significant difference in operative duration for EP-RARP and TP-RARP (Mean difference [MD]=-17.27, 95% CI=-26.89, -7.65; P=.0004), hospital stay (MD=-0.54, 95% CI=-0.94, -0.14; P=.008), and operative complications (RR=0.7, 95% CI=0.49, 0.99; P=.04). There were no noteworthy variations identified in EBL and surgical margin. Furthermore, the LRP group did not show any significant differences. This study shows that regardless of the techniques used, EP-RP has a lower risk of operative complications than TP-RP, with no significant difference in other outcomes.

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.

Comparison of incidence of acute kidney injury after robot-assisted radical prostatectomy with that after open retropubic and extraperitoneal laparoscopic radical prostatectomies in patients with prostate cancer.

We retrospectively evaluated the postoperative renal function in patients who had undergone radical prostatectomy to compare the incidences of postoperative acute kidney injury (AKI) among the patients who had undergone robot-assisted radical prostatectomy (RARP), retropubic radical prostatectomy (RRP), and extraperitoneal laparoscopic radical prostatectomy (exLRP). Patients with prostate cancer who had undergone radical prostatectomy at our institution between 2008 and 2014 were included. Robot-assisted radical prostatectomy was performed using an intraperitoneal approach in a 25-degree Trendelenburg position, whereas other procedures were performed with the patient in the supine position. We evaluated the serum creatinine levels and estimated glomerular filtration rates immediately after surgery and on postoperative day 1. We evaluated the incidence of AKI after prostatectomy using the Acute Kidney Injury Network criteria of the Kidney Disease: Improving Global Outcomes guidelines. A total of 150 consecutive patients were included, with each of the 3 groups (RARP, RRP, and exLRP) comprising 50 patients. Postoperative AKI was observed in 15 (30.0%), 1 (2.0%), and 3 (6.0%) patients in the RARP, RRP, and exLRP groups, respectively. Stage 1 AKI was observed in all the patients except one. The incidence of AKI in RARP group was significantly higher than that in the other groups (p < 0.001). In the RARP group, the serum creatinine level was significantly elevated immediately after the surgery; however, it returned to baseline on postoperative day 1. Surgical procedures were the only independent factor associated with AKI incidence. This study suggest that compared with RRP and exLRP, RARP is associated with a higher incidence of postoperative AKI, although most patients recover rapidly. Intra-abdominal pneumoperitoneum may contribute to AKI onset.

Outcomes of prostate cancer patients after robot-assisted radical prostatectomy compared with open radical prostatectomy in Korea

Limited evidence exists regarding the value of robot-assisted radical prostatectomy (RARP) in promoting health outcomes in patients with prostate cancer (PCa) in Korea, prompting a study to determine its clinical impact. The study included 15,501 patients with PCa who underwent RARP (n = 12,268) or radical prostatectomy (RP) (n = 3,233) between 2009 and 2017. The outcomes were compared using a Cox proportional hazards model after propensity score matching. Hazard ratios of all-cause overall mortality after RARP compared to that after RP within 3 and 12 months were (6.72, 2.00–22.63, p = 0.002) and (5.55, 3.31–9.31, p < 0.0001), respectively. The RARP group in four hospitals with the largest PCa surgery volume during the study period had worse percentile deaths than the total RARP patients within 3- (1.6% vs. 0.63%) and 12-month post-op (6.76% vs. 2.92%). The RARP group showed specific surgical complications, like pneumonia and renal failure, more than the RP group. A significantly higher short-term mortality and only modestly lower surgical complications occurred in RARP than RP group. RARP performance status may not be superior to that of RP as previously reported and perceived, possibly due to increased robotic surgery in the elderly. More meticulous measures are needed for robotic surgery in the elderly.

Urinary tract infection after radiation therapy or radical prostatectomy on the prognosis of patients with prostate cancer: a population-based study

BackgroundWe aimed to assess the trends in urinary tract infections (UTIs) and prognosis of patients with prostate cancer after radical prostatectomy (RP) and radiation therapy (RT) as definitive treatment options.MethodsThe data of patients diagnosed with prostate cancer between 2007 and 2016 were collected from the National Health Insurance Service database. The incidence of UTIs was evaluated in patients treated with RT, open/laparoscopic RP, and robot-assisted RP. The proportional hazard assumption test was performed using the scaled Schoenfeld residuals based on a multivariable Cox proportional hazard model. Kaplan–Meier analysis were performed to assess survival.ResultsA total of 28,887 patients were treated with definitive treatment. In the acute phase (< 3 months), UTIs were more frequent in RP than in RT; in the chronic phase (> 12 months), UTIs were more frequent in RT than in RP. In the early follow-up period, the risk of UTIs was higher in the open/laparoscopic RP group (aHR, 1.63; 95% CI, 1.44–1.83; p < 0.001) and the robot-assisted RP group (aHR, 1.26; 95% CI, 1.11–1.43; p < 0.001), compared to the RT group. The robot-assisted RP group had a lower risk of UTIs than the open/laparoscopic RP group in the early (aHR, 0.77; 95% CI, 0.77–0.78; p < 0.001) and late (aHR, 0.90; 95% CI, 0.89–0.91; p < 0.001) follow-up periods. In patients with UTI, Charlson Comorbidity Index score, primary treatment, age at UTI diagnosis, type of UTI, hospitalization, and sepsis from UTI were risk factors for overall survival.ConclusionsIn patients treated with RP or RT, the incidence of UTIs was higher than that in the general population. RP posed a higher risk of UTIs than RT did in early follow-up period. Robot-assisted RP had a lower risk of UTIs than open/laparoscopic RP group in total period. UTI characteristics might be related to poor prognosis.

MP73-17 WHOLE GLAND ABLATION USING HIGH-INTENSITY FOCUSED ULTRASOUND VERSUS ROBOT-ASSISTED RADICAL PROSTATECTOMY: A PROPENSITY SCORE-MATCHED STUDY

You have accessJournal of UrologyCME1 Apr 2023MP73-17 WHOLE GLAND ABLATION USING HIGH-INTENSITY FOCUSED ULTRASOUND VERSUS ROBOT-ASSISTED RADICAL PROSTATECTOMY: A PROPENSITY SCORE-MATCHED STUDY Jin Noh, Gyoohwan Jung, Hae Sung Lee, Jun Hyun Nam, Jung Kwon Kim, Sangchul Lee, Seong Jin Jeong, Jong Jin Oh, Seok-Soo Byun, Sung Kyu Hong, and Hakmin Lee Jin NohJin Noh More articles by this author , Gyoohwan JungGyoohwan Jung More articles by this author , Hae Sung LeeHae Sung Lee More articles by this author , Jun Hyun NamJun Hyun Nam More articles by this author , Jung Kwon KimJung Kwon Kim More articles by this author , Sangchul LeeSangchul Lee More articles by this author , Seong Jin JeongSeong Jin Jeong More articles by this author , Jong Jin OhJong Jin Oh More articles by this author , Seok-Soo ByunSeok-Soo Byun More articles by this author , Sung Kyu HongSung Kyu Hong More articles by this author , and Hakmin LeeHakmin Lee More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003341.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We compared the clinical outcomes of robot-assisted radical prostatectomy (RARP) and whole gland ablation (WGA) using high-intensity focused ultrasound (HIFU) in localized prostate cancer. METHODS: We analyzed 3,806 patients who had undergone RARP and WGA using HIFU. According to the propensity score for each treatment, 84 patients after WGA were matched to 3,722 patients after RARP at a 1:4 ratio using the nearest neighbor method. RESULTS: The matched cohort comprised 420 subjects (RARP, 336; PGA, 84), with a median follow-up period of 26 months. Treatment failures were identified in 16.7% and 15.5% of patients in the WGA and RARP groups, respectively. Kaplan-Meier analyses revealed no significantly failure-free (p=0.999) and salvage-free survival (p=0.548) in the RARP group than in the WGA group. There was no significant difference in the postoperative urinary symptom score (p=0.630), but the postoperative erectile function score in group of preoperative international index of erectile function (IIEF)≥17 was significantly higher in the WGA group (p=0.030). The rate of urinary incontinence (any pad) was lower in the WGA group than that in the RARP group (10.7% vs 20.2%, p=0.057). Postoperative complications were more frequent in the WGA group (p<0.001); however, there was no significant difference in high-grade complications (≥3) (p=0.201). CONCLUSIONS: WGA using HIFU showed statistically similar oncological outcomes compared with RARP for failure-free survival and salvage-free survival. However, functional outcomes regarding erectile function in selective group and postoperative incontinence were more favorable in the WGA group. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1042 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jin Noh More articles by this author Gyoohwan Jung More articles by this author Hae Sung Lee More articles by this author Jun Hyun Nam More articles by this author Jung Kwon Kim More articles by this author Sangchul Lee More articles by this author Seong Jin Jeong More articles by this author Jong Jin Oh More articles by this author Seok-Soo Byun More articles by this author Sung Kyu Hong More articles by this author Hakmin Lee More articles by this author Expand All Advertisement PDF downloadLoading ...

Quality of life in patients who underwent robot‐assisted radical prostatectomy compared with those who underwent low‐dose‐rate brachytherapy

To compare the quality of life (QOL) in patients who underwent robot-assisted radical prostatectomy (RARP) or low-dose-rate brachytherapy (LDR-BT) for prostate cancer. We enrolled patients who underwent LDR-BT (LDR-BT alone [n = 540] or LDR-BT plus external beam radiation therapy [n = 428]) and RARP (n = 142). QOL was evaluated using the International Prostate Symptom Score, Expanded Prostate Cancer Index Composite (EPIC), Sexual Health Inventory for Men (SHIM), and 8-item Short Form (SF-8) health survey. The two groups were compared using propensity score matching analysis. At 24 months after treatment, the number of patients with worsened urinary QOL in the urinary domain of EPIC compared with baseline was 78/111 (70%) and 63/137 (46%) in the RARP and LDR-BT groups, respectively (p < 0.001). In the urinary incontinence and function domain, this number was higher in the RARP group versus the LDR-BT group. However, in the urinary irritative/obstructive domain, the number of patients with improved urinary QOL at 24 months compared with baseline was 18/111 (16%) and 9/137 (7%), respectively (p = 0.01). Regarding the SHIM score, sexual domain of EPIC, and mental component summary of SF-8, there were more number of patients with worsened QOL in the RARP group than in the LDR-BT group. In the EPIC bowel domain, the number of patients with worsened QOL was lower in the RARP group versus the LDR-BT group. The differences in QOL observed between patients treated with RARP and LDR-BT could assist in treatment selection for prostate cancer.

A Study of 57 Patients with Prostate Cancer to Compare Outcomes of Estimated Blood Loss and Postoperative Pain Between Robot-Assisted Laparoscopic Radical Prostatectomy and Standard Laparoscopic Radical Prostatectomy.

BACKGROUND Robot-assisted radical prostatectomy (RARP) is becoming an increasingly common method for treatment of prostate cancer. This study aimed to compare outcomes of estimated blood loss and postoperative pain, determined by patient-controlled analgesia (PCA), between RARP and standard laparoscopic radical -prostatectomy (LRP). MATERIAL AND METHODS We enrolled 57 patients who had localized prostate cancer (28 patients in RARP, 29 patients in LRP). Primary outcomes were estimated blood loss (EBL) measured by gravimetric method for gauze and visual estimation for suction bottle, and PCA bolus count that the bolus doses were injected at the 1st, the 6th, the 24th, and the 48th hour after the operation. We recorded anesthesia and operation time, pneumoperitoneum duration, vital signs, fluid volume, and remifentanil use. Using the numeric rating scale (NRS), adverse effects were checked at the 1st, the 6th, the 24th, and the 48th hour and patient satisfaction was assessed at the 48th hour after the operation. RESULTS Anesthesia time, operation time, and gas insufflation time were longer (P=0.001, P=0.003, P=0.021), and patient-controlled analgesia (PCA) bolus counts at the 1st hour after the operation and volumes of administered crystalloid and remifentanil were higher in the RARP group than in the LRP group (P=0.013, P=0.011, P=0.031). There were no significant differences in EBL. CONCLUSIONS The RARP group required longer anesthetic time and more analgesics during the acute postoperative period compared to the LRP group. Regarding anesthesia, LRP is as good a surgical procedure as RARP until the operation time and the number of ports are reduced.

Comparison of oncological and functional outcomes of perineoscopic radical prostatectomy and robot-assisted radical prostatectomy.

The aim of this study is to compare the functional, oncological, and complication outcomes of perineoscopic radical prostatectomy (PeRP) and robot-assisted radical prostatectomy (RARP) operations. Patients who underwent radical prostatectomy (RP) between October 2018 and June 2020 for localized prostate cancer (N0, < T3) were retrospectively screened. After the exclusion criteria, 56 patients who underwent PeRP and 67 patients who underwent RARP remained in the study. Demographic, perioperative, and postoperative data were collected. In functional outcomes, continence and potency status were compared at 1, 3, 6, and 12months. The mean age of the patients was 61.3 ± 5.9years in the PeRP group and 62.2 ± 5.7years in the RARP group. No statistically significant differences were present between preoperative and postoperative values. Among the perioperative findings, the mean operation time was 90.4 ± 11.2min for the PeRP group and 114.6 ± 14.7min for the RARP group. The operation time was shorter in the PeRP group. The average hospital stay was 2 ± 0.6days in the PeRP group and 2.3 ± 0.5days in the RARP group. It was significantly shorter in the PeRP group. There is no statistically significant difference between the two groups in the oncological and functional results. PeRP is a surgical procedure safe in low-risk patients with medium-risk prostate cancer (PCa) who do not require lymph-node dissection. Moreover, PeRP minimizes the difficulties of perineal surgery.

Minimal residual membranous urethral length and membranous urethral length predict poor recovery from incontinence after robot-assisted radical prostatectomy and after open radical prostatectomy.

To investigate how much minimal residual membranous urethral length (mRUL) and maximal urethral length (MUL) measured on MRI preoperatively affect postoperative urinary incontinence (PUI) and recovery in robot-assisted radical prostatectomy (RARP) and open radical prostatectomy (ORP). The subjects were 190 and 110 patients undergoing RARP and ORP, respectively, in our institution. Patients underwent preoperative MRI for prostate cancer evaluation and completed the quality of life questionnaire of the Expanded Prostate Cancer Index Composite instrument before and 1, 3, 6, and 12 months after surgery. The parameters of mRUL and MUL were measured on MRI and analyzed along with other parameters including age, body mass index, and nerve sparing. The median mRUL and MUL were 7.81 and 14.27 mm in the RARP group and 7.15 and 13.57 mm in the ORP group, respectively. Recovery rates from PUI were similar in the two groups. Multivariate analyses showed that mRUL was a predictor of baseline continence, whereas shorter MUL was a predictor of poor recovery from PUI. Patients with both shorter mRUL and MUL had significantly worse recoveries from PUI after RARP and ORP than patients with longer mRUL and MUL. Minimal residual membranous urethral length contributes to urethral function as basal urinary continence, whereas MUL represents the potential of recovery from PUI in RARP and ORP. The MUL measured by preoperative MRI can predict poor recovery from PUI after radical prostatectomy and combined evaluation of MUL and mRUL support to anticipate poor recovery of PUI.

Comparative assessment of the learning curve of retropubic, laparoscopic, perineal, and robot-assisted radical prostatectomy

Introduction. The learning curve (LC) of radical prostatectomy (RP) is an actual problem in contemporary urology.Objective. To assess the LC of retropubic (rpRP), perineal (plRP), laparoscopic (LRP), and robot-assisted radical prostatectomy (RARP).Materials and methods. The study included 400 patients with localized or locally advanced prostate cancer (T1cT3bN0M0) who underwent rpRP, plRP, LRP or RARP performed by a single surgeon. Exclusion criteria: refusal of surgical treatment, metastatic prostate cancer, primary multiple cancer, neoadjuvant hormonal, radiation or chemotherapy.Results. Progressive improvement of metric indicators was noted in all groups as the surgical technique was mastered. Maximum rates of reaching the plateau of satisfactory functional and early oncological results were demonstrated in the RARP group after 25 – 50 procedures. In terms of the duration of the surgery, the LRP group showed the longest mastering period of 75 – 100 cases. Regression of blood loss volume requires 50 – 75 procedures in the rpRP and LRP groups, and 25 – 50 approaches in the rpRP and RARP groups. RARP demonstrates advantages in the context of minimization of catheterization time and inpatient period (25 – 50 cases). rpRP is not only associated with a maximum amount (n = 30) and frequency (21,0%) of complications, but also with a relatively long period of reaching a plateau of 50 – 75 cases. The stabilization of functional results is proceeding at the maximum pace in the RARP group at 25 – 50 procedures, in the other groups at 50 – 75 cases. Oncological safety (positive surgical margin) in the LRP, rpRP and RARP groups is achievable after 25 – 50 cases, in the rpRP group at 50 – 75 cases.Conclusion. The period of RP mastering depends on surgical approaches. RARP demonstrates the shortest LC duration.

Comparison of Retzius-sparing versus standard robot-assisted radical prostatectomy for prostate cancer

Introduction and objectivesWe aim to compare the first year oncological and functional outcomes of Retzius-sparing robot-assisted radical prostatectomy (Rs-RARP) and standard robot-assisted radical prostatectomy (RARP). Materials and methodsEighty-eight patients who underwent robotic radical prostatectomy between 2018–2019 were included. We compared the minimum one-year follow-up results of patients who underwent Rs-RARP or RARP in terms of oncological and functional outcomes. Potency was assessed with the Sexual Health Inventory for Men (SHIM) score and was defined as an erection sufficient for penetration. Continence was defined as the absence of urinary incontinence with no safety pad. Patients were evaluated in the first month of follow-up and subsequently, every three months. ResultsForty-six patients in Rs-RARP and 42 patients in the RARP group were enrolled. Catheter removal time was shorter in the Rs-RARP group (12 vs. 14 days, p = 0.001). At the 1st month visit, 41 patients (%89) were continent (no pads) in the Rs-RARP group while 25 patients (%59) were continent in the RARP group (p = 0.001). Patients who underwent Rs-RARP achieved faster recovery of urinary continence (Log-rank, p = 0.001). After one year of follow-up, 43 patients (93%) in Rs-RARP group and 38 patients (90%) in RARP group were continent (p = 0.6). Potency rates were 38.7% in Rs-RARP and 34.4% in RARP group (p = 0.28). There were no cases of biochemical recurrence in any group. ConclusionsRs-RARP is a feasible technique, providing early return of continence. However, overall continence rates were similar at the end of the one-year follow-up.

Comparación entre la prostatectomía con preservación del espacio de Retzius y la prostatectomía radical estándar asistida por robot para el cáncer de próstata

Introduction and objectivesWe aim to compare the first year oncological and functional outcomes of Retzius-sparing robot-assisted radical prostatectomy (Rs-RARP) and standard robot-assisted radical prostatectomy (RARP). Materials and methodsEighty-eight patients who underwent robotic radical prostatectomy between 2018-2019 were included. We compared the minimum one-year follow-up results of patients who underwent Rs-RARP or RARP in terms of oncological and functional outcomes. Potency was assessed with the Sexual Health Inventory for Men (SHIM) score and was defined as an erection sufficient for penetration. Continence was defined as the absence of urinary incontinence with no safety pad. Patients were evaluated in the first month of follow-up and subsequently, every three months. ResultsForty-six patients in Rs-RARP and 42 patients in the RARP group were enrolled. Catheter removal time was shorter in the Rs-RARP group (12 vs. 14 days, P=.001). At the 1st month visit, 41 patients (%89) were continent (no pads) in the Rs-RARP group while 25 patients (%59) were continent in the RARP group (P=.001). Patients who underwent Rs-RARP achieved faster recovery of urinary continence (Log-rank, P=.001). After one year of follow-up, 43 patients (93%) in Rs-RARP group and 38 patients (90%) in RARP group were continent (P=.6). Potency rates were 38.7% in Rs-RARP and 34.4% in RARP group (P=.28). There were no cases of biochemical recurrence in any group. ConclusionsRs-RARP is a feasible technique, providing early return of continence. However, overall continence rates were similar at the end of the one-year follow-up.

Functional Preservation and Oncologic Control following Robot-Assisted versus Laparoscopic Radical Prostatectomy for Intermediate- and High-Risk Localized Prostate Cancer: A Propensity Score Matched Analysis.

Aim To evaluate the urinary continence (UC), erectile function, and cancer control obtained following robot-assisted radical prostatectomy (RARP) and laparoscopic radical prostatectomy (LRP) for intermediate- and high-risk localized prostate cancer (PCa). Materials and Methods 232 patients bearing intermediate- and high-risk localized PCa were enrolled in this study. Perioperative, functional, and oncological outcomes were analyzed after applying the propensity score matched method. Results Within the matched cohort, the RARP group was corrected with a significantly shorter mean operative time than the LRP group (p < 0.001). Patients in the RARP arm were also at a lower risk of ≤ Grade II complications than those in the LRP group (p = 0.036). Meanwhile, the proportions of transfusion and ≥ Grade II complications in the RARP group were similar to those in the LRP group (p = 0.192 and p = 1.000, respectively). No significant differences regarding the rates of pT3 disease and positive surgical margin existed between the two groups. RARP versus LRP tended to a significantly higher percentage of UC recovery within the follow-up period. Significant differences were also found between the RARP and LRP arms in terms of erectile function at postoperative 6 months and the last follow-up (p = 0.013 and p = 0.009, respectively). Statistical comparability in biochemical recurrence-free survival was observed between the two groups (p = 0.228). Conclusions For the surgical management of intermediate- and high-risk localized PCa, RARP tended to a lower risk of ≤ Grade II complications and superior functional preservation without cancer control being compromised than LRP.

283 Salvage Versus Primary Robot-Assisted Radical Prostatectomy: A Propensity-Matched Comparative Effectiveness Study from A High-Volume Tertiary Centre

Abstract Aim Salvage Robot-Assisted Radical Prostatectomy (sRARP) is a potential treatment option for locally recurrent Prostate Cancer after non-surgical primary treatment. There are minimal data comparing outcomes between propensity-matched salvage and primary Robot-Assisted Radical Prostatectomy (RARP). We compare perioperative, oncological, and functional outcomes of sRARP with primary RARP and between sRARP post-whole and focal gland therapy. Method 1:1 propensity-matched comparison of 146 sRARP with primary RARP from a cohort of 3,852 consecutive patients from a high-volume tertiary centre. Results There were no significant differences in patient characteristics between the salvage and primary RARP groups. Grade III-V Clavien-Dindo complication rates were 1.3% and 0% in the salvage and primary groups, respectively (p = 0.310). Median (IQR) follow-up was 16 (10,30) and 21 (13,33) months in the salvage and primary groups, respectively. BCR rates were 30.8% and 13.7% in the salvage and primary groups, respectively (p &amp;lt; 0.001). Pad-free continence rates were 79.1% and 85.4% at two years in the salvage and primary groups, respectively (p = 0.160). ED rates were 95.2% and 77.4% in the salvage and primary groups, respectively (p &amp;lt; 0.001). Comparing the whole gland and focal gland groups, BCR rates were 33.3% and 29.1%, respectively (p = 0.687), pad-free continence rates were 66% and 89.3%, respectively (p = 0.001), and ED rates were 98.3% and 93%, respectively (p = 0.145). Conclusions SRARP has similar perioperative but inferior oncological outcomes to primary RARP. Continence rates are similar to primary RARP, but potency is worse. Perioperative and oncological outcomes of sRARP after focal gland therapy are similar but continence outcomes are superior compared to sRARP after whole gland therapy.