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Purpose: Robot-assisted simple prostatectomy (RASP) for benign prostatic hyperplasia (BPH) is a recently described surgical approach, but comparison with open simple prostatectomy (OSP) lack in the literature. We compared perioperative outcomes of OSP versus RASP. Methods: Patients who underwent simple prostatectomy between 2017 and 2020 were included in this retrospective study. OSP was performed by the transvesical technique and RASP was performed with a DaVinci Xi robot, using the transvesical extraperitoneal approach. Perioperative and postoperative data were compared and complications risk factors for complications were identified. Results: and limitations. Overall, 103 patients were included (median age 72 years [IQR = 67–76]). Forty-seven underwent RASP and 56 OSP. The median volume of the prostate gland was 130 mL [IQR = 100–180] in the RASP group and 126 mL [IQR = 100–160] in the OSP group. RASP was associated with a significant reduction in blood loss (median 200 vs. 400 mL; p < 0.001), shorter hospital stay (5 vs. 10 days; p < 0.001) and median catheterisation time (4 vs. 9 days; p < 0.001). In the RASP group, there were fewer grade ≥ 2 complications (2 (4.3%) vs. 13 (23.2%); p = 0.005) and less need for transfusions (0 vs. 6 (11%), p = 0.005). Preoperative prostate volume was a risk factor for complications (OR = 1.2 [95% CI 1.1–1.5]; p = 0.01) while robot-assisted surgery was a protective factor (OR 0.3 [95% CI 0.05–0.9]; p = 0.05). Functional outcomes between the two groups were identical at 12 months follow up. Conclusion: RASP is a safe and effective procedure. When compared with OSP, RASP was associated with decreased morbidity as well as reduced hospital stay and catheterisation time. Functional outcomes were comparable to the open approach. [ABSTRACT FROM AUTHOR]

Holmium laser enucleation of the prostate (HoLEP) is a valid alternative to transurethral resection of the prostate and open simple prostatectomy for the treatment of a larger prostate, demonstrating comparable efficacy and lower morbidity. One of the most bothersome symptoms after HoLEP is urinary incontinence (UI), which is present in almost 20% of patients, with a recovery rate of over 80% at 3 months. A relevant risk factor linked to UI is the damage of the external sphincter during the enucleation of adenoma tissue close to it. In our modified HoLEP technique named Cap HoLEP, we preserve the anterior prostate portion proximal to the external sphincter. This cap of adenoma could reduce mechanical stress and laser energy widespread on the sphincter, acting as a protective barrier. The aim of this study was to describe the Cap HoLEP technique and to evaluate its safety and efficacy by assessing peri-operative and functional outcomes. We enrolled all patients who consecutively underwent Cap HoLEP from December 2017 to October 2019 in our hospital. Baseline characteristics; the International Prostate Symptom Score; uroflow findings; intraoperative data, intraoperative, and postoperative complications; and UI were all assessed. The median operative time was 122 min with 138 kJ of laser energy delivered. Median ∆Hb was 0.8 gr/dL. Seven low-grade complications were recorded. At 1 month, 34.8% of patients presented UI, 16.7% urge incontinence, 13.6% stress incontinence, and 4.5% mixed incontinence. At 3 months, UI showed a significant improvement, decreasing to 12.1%. At 6 and 12 months, UI was 7.6% and 3%, respectively. Our modified HoLEP technique is safe and effective, allowing significant improvement in the postoperative UI rate. [ABSTRACT FROM AUTHOR]