INTRODUCTION AND OBJECTIVE: Simple prostatectomy isthe treatment of choice for symptomatic benign prostatic hyperplasia(BPH), and it should be recommended in prostate glands>80cc.Although functional outcomes of the open approach (OSP) are un-doubtedly favourable, the robotic approach (RASP) is gainingconsensus thanks to its safety and reduced morbidity. However, data ofRASP is scarce, and the majority of published series described smallcohorts with short follow-up. We aimed to investigate perioperativeoutcomes of RASP and OSP in a large cohort of patients from twourological referral centres.METHODS: We analyzed data of 357 consecutive men withsymptomatic BPH who received OSP or RASP at two referral centres[OLV Hospital (Aalst, Belgium) and United Hospitals (Ancona, Italy)]from 2011 to 2021. Multivariable regressions (MVA) investigated vari-ables associated with postoperative complications after adjusting forage, Body Mass Index (BMI), Charlson Comorbidity Index (CCI),prostate volume, concurrent bladder stone or diverticula, indwellingcatheter, surgical approach (OSP vs. RASP), operative time (OT) andestimated blood loss (EBL).RESULTS: A total of 201 (56%) and 156 (44%) men receivedOSP and RASP, respectively. Overall, median (interquartile range[IQR]) age and CCI were 70 (65-76) years and 3 (2-4), with no differ-ences between the groups (both p>0.05). Median [IQR] prostate vol-ume was slightly higher in the RASP vs. OSP group (median: 164 vs.153 cc; p[0.08). As compared to men receiving OSP, OT was longer inthe RASP group (124 vs. 89 minutes), with lower EBL (395 vs. 761 ml),shorter catheterisation time (3 vs. 10 days) and length of stay (LOS) (4vs. 8 days; all medians; all p<0.001). The rate of overall post-operativecomplications was higher in the OSP vs. RASP group (33% vs. 24%;p[0.05), especially of Clavien-Dindo grade 3 (15% vs. 5%;p[0.003), with higher rates of postoperative blood transfusions (28%vs. 1%; p<0.001). On MVA, the probability of postoperativecomplications was higher for older men (odds ratio [OR]: 1.13; 95%confidence interval [CI]: 1.07, 1.23; p[0.047) and for men who hadhigher EBL (OR: 1.45; 95%CI: 1.02, 1.53; p[0.001), whereas theassociation between surgical approach and overall postoperativecomplications was not statistically significant (OR: 0.88; 95% CI 0.64,1.27; p[0.1).CONCLUSIONS: As compared to OSP, RASP allows for lowerpostoperative complications and blood transfusions and thus, it mightbe considered an option for the treatment of symptomatic BPH ac-cording to physician's preference.
PERI-OPERATIVE OUTCOMES OF OPEN VERSUSROBOT-ASSISTED SIMPLE PROSTATECTOMY: RESULTS FROMTWO HIGH-VOLUME CENTRES / Scarcella, Simone; Mottaran, Angelo; Andrea Bravi, Carlo; Sarchi, Luca; Piazza, Pietro; Paciotti, Marco; Amato, Marco; Puliatti, Stefano; Umari, Paolo; Giuloni, Carlo; Milanese, Giulio; Dell'Atti, Lucio; Castellani, Daniele; Lambert, Edward; Vollemaere, Jonathan; Develtere, Dries; Veys, Ralf; Goossens, Marijn; Van der Jeugt, Jolien; Galosi, Andrea Benedetto; Alexandre Mottrie, And. - In: THE JOURNAL OF UROLOGY. - ISSN 0022-5347. - 207(5S):(2022), pp. 787-787. [10.1097/JU.0000000000002613.11]
PERI-OPERATIVE OUTCOMES OF OPEN VERSUSROBOT-ASSISTED SIMPLE PROSTATECTOMY: RESULTS FROMTWO HIGH-VOLUME CENTRES
Simone Scarcella;Giulio Milanese;Lucio Dell’Atti;Daniele Castellani;Andrea Galosi;
2022-01-01
Abstract
INTRODUCTION AND OBJECTIVE: Simple prostatectomy isthe treatment of choice for symptomatic benign prostatic hyperplasia(BPH), and it should be recommended in prostate glands>80cc.Although functional outcomes of the open approach (OSP) are un-doubtedly favourable, the robotic approach (RASP) is gainingconsensus thanks to its safety and reduced morbidity. However, data ofRASP is scarce, and the majority of published series described smallcohorts with short follow-up. We aimed to investigate perioperativeoutcomes of RASP and OSP in a large cohort of patients from twourological referral centres.METHODS: We analyzed data of 357 consecutive men withsymptomatic BPH who received OSP or RASP at two referral centres[OLV Hospital (Aalst, Belgium) and United Hospitals (Ancona, Italy)]from 2011 to 2021. Multivariable regressions (MVA) investigated vari-ables associated with postoperative complications after adjusting forage, Body Mass Index (BMI), Charlson Comorbidity Index (CCI),prostate volume, concurrent bladder stone or diverticula, indwellingcatheter, surgical approach (OSP vs. RASP), operative time (OT) andestimated blood loss (EBL).RESULTS: A total of 201 (56%) and 156 (44%) men receivedOSP and RASP, respectively. Overall, median (interquartile range[IQR]) age and CCI were 70 (65-76) years and 3 (2-4), with no differ-ences between the groups (both p>0.05). Median [IQR] prostate vol-ume was slightly higher in the RASP vs. OSP group (median: 164 vs.153 cc; p[0.08). As compared to men receiving OSP, OT was longer inthe RASP group (124 vs. 89 minutes), with lower EBL (395 vs. 761 ml),shorter catheterisation time (3 vs. 10 days) and length of stay (LOS) (4vs. 8 days; all medians; all p<0.001). The rate of overall post-operativecomplications was higher in the OSP vs. RASP group (33% vs. 24%;p[0.05), especially of Clavien-Dindo grade 3 (15% vs. 5%;p[0.003), with higher rates of postoperative blood transfusions (28%vs. 1%; p<0.001). On MVA, the probability of postoperativecomplications was higher for older men (odds ratio [OR]: 1.13; 95%confidence interval [CI]: 1.07, 1.23; p[0.047) and for men who hadhigher EBL (OR: 1.45; 95%CI: 1.02, 1.53; p[0.001), whereas theassociation between surgical approach and overall postoperativecomplications was not statistically significant (OR: 0.88; 95% CI 0.64,1.27; p[0.1).CONCLUSIONS: As compared to OSP, RASP allows for lowerpostoperative complications and blood transfusions and thus, it mightbe considered an option for the treatment of symptomatic BPH ac-cording to physician's preference.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
