Management of large-volume prostate adenomas remains challenging in benign prostatic hyperplasia (BPH). This study evaluated surgical techniques, perioperative outcomes, functional results, and complication rates of robot-assisted simple prostatectomy (RASP) in a multi-institutional cohort. Methods: a retrospective analysis included patients who underwent RASP between January 2013 and July 2024 at 17 centers in Europe and the United States. Functional outcomes including uroflowmetry, post-void residual volume (PVR), International Prostate Symptom Score (IPSS), and Quality of Life (QoL), were evaluated at 6 weeks and 1 year postoperatively. Statistical significance was set at p<0.05 (paired t-test). Postoperative complications were assessed at 30 and 90 days. Surgical techniques were systematically analyzed and video-validated.
a total of 1345 patients underwent RASP. Median age was 70 years (IQR 65–76), median prostate volume 140 ml (IQR 110–180). Median operative time was 144 min (IQR 116–180) with median blood loss of 300 ml (IQR 150–440). Functional outcomes are shown inTable 1. Clavien–Dindo ≥ III complications occurred in 41/1344 (3%) at 30 days and 6/1218 (0.5%) at 90 days. Regarding surgical technique, 1196/1345 (89%) were treated with the DaVinci multiport system, 94/1345 (7%) with the SinglePort, and 55/1345 (4%) with the Hugo-RAS system. A transperitoneal approach was used in 1023/1345 (76%) and an extraperitoneal in 321/1345 (24%). Transvesical access was applied in 719/1344 (54%) and transcapsular in 625/1344 (46%). Standard enucleation was performed in 1151/1345 (86%), urethra-sparing in 186/1345 (14%). After standard enucleation, no closure of the prostatic fossa was performed in 363/1151 (32%), posterior vesico-urethral reconstruction (180°) in 297/1151 (26%), and full vesico-urethral reconstruction (360°) in 441/1151 (38%).
Robot-assisted simple prostatectomy provides significant improvements in urinary function and quality of life for patients with large-volume prostatic adenoma, with low perioperative morbidity and stable outcomes at 1 year. Despite variations in surgical techniques across centers, postoperative outcomes were consistent throughout this large multi-institutional cohort.
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