Evaluation of the retropubic approach to robotic simple prostatectomy

Background: There are several surgical options for the treatment of Benign Prostatic Hyperplasia (BPH). The retropubic approach to a robotic simple prostatectomy has been previously described as an acceptable option for patients with large prostates (greater than 80–100 g). We present 15 cases who were candidates for robotic simple prostatectomy via a retropubic approach. Objective: To describe the retropubic approach to robotic simple prostatectomy alongside relevant quantifiers of patient outcomes and quality of life measures. Patient and surgical procedure: We report the case series of 15 patients diagnosed with BPH and underwent robotic simple prostatectomy via a retropubic approach between June 2020 and June 2023. Results: The mean total operative time was 182.4 min (median 176 min), the mean estimated blood loss was 122 ml, the median catheter time was 9 days (commonly 7 days for patients) and the average length of stay was 35 h. The average prostate size was 107.2 g and the average resected specimen weight was 66.1 g. IPSS improved on average 8.9 points with an improvement in QOL by 2.3 points. The mean post operative post void residual volume (PVR) was 74.2 ml, and the PVR had a significant change of 279.3 ml on average when comparing pre and postoperatively. There was an improvement in urinary flow rate when comparing the preoperative and postoperative (9.4 and 13.4 ml/s, respectively). Surgical indications included 14 patients with urinary retention, three patients with a history of recurrent UTIs, and two patients with bladder stones. No transfusions were required. Postoperatively, one patient had recurrent UTIs and one had a neurogenic bladder. When assessing for postoperative strictures or de novo urinary incontinence, none were identified. Conclusion: Utilizing a retropubic technique for a robotic assisted simple prostatectomy demonstrated excellent functional outcomes and limited risk. The superior visualization of the apex of the prostate and simple capsular closure resulted in no postoperative strictures or de novo urinary incontinence.