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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., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

For large prostate volume, open simple prostatectomy (OSP) or holmium laser enucleation are the gold standard surgical treatment medical therapy failure. Robot-assisted simple prostatectomy (RASP) has recently been proposed as an alternative to OSP and endoscopic techniques. Our objective was to describe our extraperitoneal RASP technique for patients with benign prostate obstruction (BPO), and to report on perioperative and mid-term functional outcomes. Data were collected prospectively for all consecutive patients who underwent RASP in our high-volume tertiary hospital over a 6-year period. International Prostate Symptom Score (IPSS), International Index of Erectile Function-5 (IIEF-5) and uroflow findings were compared before and after surgery. Intraoperative and postoperative outcomes were also assessed. Forty-seven patients were included in the study. There was no intraoperative incident and no blood transfusion was needed after surgery. Median time to bladder catheter removal was 4 days and patients were discharged the day after. Within 90 postoperative days, 6 patients (12%) experienced at least one complication, all low-grade except one (2.1%) which was Clavien IIIa grade. By univariate analysis, the only risk factor for postoperative complications was the Charlson comorbidity index (OR = 2.1, 95% CI = [1.1-4.7], p = 0.04). At 12 months, a significant improvement IPSS and uroflow rate was observed. No patient reported stress urinary incontinence. Extraperitoneal RASP appears to be a safe and effective technique for men with LUTS related to large BPO. RASP is less invasive than OSP and wide diffusion of the robot-system could lead to the rapid implementation of RASP as a treatment for large prostate., (© 2022. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.)

Radical prostatectomy (RP) is the standard surgical treatment of organ-confined prostate cancer in patients with a life expectancy of at least 10 years. In a recent prospective study, we described the PERUSIA (Posterior, Extraperitoneal, Robotic, Under Santorini, Intrafascial, Anterograde) technique, which is an extraperitoneal full nerve sparing robotic RP, showing its feasibility and safety. The aim of this retrospective study was to evaluate the peri-operative, oncologic, and functional outcomes of the PERUSIA technique. We retrospectively analyzed the data of 454 robotic-assisted radical prostatectomies (RARP) performed using the PERUSIA technique from January 2012 to October 2019. We evaluated perioperative outcomes (operative time, estimated blood loss, catheterization time, complication rate, length of stay), oncological (positive surgical margins and biochemical recurrence), and functional outcomes in terms of urinary continence and sexual potency. The overall complication rate was 16%, positive surgical margins were 8.1%, and biochemical recurrence occurred in 8.6% at median follow-up of 47 months. Urinary continence was achieved in 69% of cases the day after the removal of the catheter, in 92% at 3 months, and in 97% at 12 months after surgery. The average rate of sexual potency was 72% and 82% respectively 3 and 12 months after surgery. Our findings show that the PERUSIA technique is a safe extraperitoneal approach to perform a full nerve sparing technique providing exciting functional outcomes. [ABSTRACT FROM AUTHOR]