Single-port transvesical simple prostatectomy for the surgical treatment of benign prostatic hyperplasia: functional and continence outcomes.

IF 5.1 2区医学 Q1 ONCOLOGY Prostate Cancer and Prostatic Diseases Pub Date : 2024-11-19 DOI:10.1038/s41391-024-00923-y

Matteo Pacini, Luca Lambertini, Giulio Avesani, Juan R Torres Anguiano, Luca Morgantini, Alec Martin, Ruben Sauer Calvo, Hakan B Haberal, Gabriele Bignante, Andrea Minervini, Alessandro Zucchi, Riccardo Bartoletti, Simone Crivellaro

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Abstract

Background: Robot-Assisted Simple Prostatectomy (RASP) is recommended for the treatment of large prostate glands. The introduction of the Single-Port (SP) platform in 2018 has enabled transvesical approach to SP-RASP with promising outcomes. Our aim was to describe the functional and urinary continence outcomes of SP-RASP.

Methods: Clinical and surgical data from all consecutive patients who underwent transvesical SP-RASP between February 2020 and March 2024 were collected in a prospectively maintained institutional dataset and retrospectively analyzed. All procedures were performed using the da Vinci SP platform without any conversions to open surgery. Postoperative outcomes were gathered and analyzed, with a particular focus on the incidence of urinary incontinence (UI) and the time to continence recovery.

Results: Overall, 89 patients underwent SP-RASP, with a median prostate size of 110 grams (90-171.5) and a median PSA level of 5.5 mg/dl (2.77-10.93). All patients were on at least one prostate medication prior to surgery. Preoperative evaluations showed a median International Prostate Symptoms Score (IPSS) of 23 (20-27), Quality of Life (QoL) of 4 (3-5), and Post-voiding Residual (PVR) of 153 ml (60-400). The median operative time was 180 min (164-200), with a median estimated blood loss of 100 ml (30-180). Postoperatively, no patients required continuous bladder irrigation. The median postoperative opioid intake was 6.5 morphine equivalents (0-10), with over 78% not requiring narcotics after discharge. Overall, 77.5% were same day discharged. No Clavien-Dindo > 2 complications were recorded. The median follow-up time was 18 (7-35) months. At the last postoperative urological evaluation, the median IPSS was 5 (3-7), QoL was 1 (0-2), and PVR was 10 ml (0-25). Only 4 patients (4.5%) experienced UI postoperatively, and all were continent within 3 months.

Conclusions: The UI incidence rate and functional outcomes of SP-RASP are very encouraging, likely due to precise adenoma and urethra dissection and bladder neck reconstruction. This approach also allows for same-day discharge.

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用于良性前列腺增生手术治疗的单孔经膀胱单纯前列腺切除术：功能和尿失禁疗效。

背景：机器人辅助单纯前列腺切除术（RASP）被推荐用于治疗大前列腺腺体。2018年，单孔（SP）平台的引入使经膀胱的SP-RASP方法成为可能，并取得了可喜的成果。我们的目的是描述 SP-RASP 的功能和尿失禁疗效：2020年2月至2024年3月期间接受经膀胱SP-RASP的所有连续患者的临床和手术数据被收集到一个前瞻性维护的机构数据集中，并进行回顾性分析。所有手术均使用达芬奇 SP 平台进行，没有任何转为开放手术的情况。收集并分析了术后结果，重点关注尿失禁（UI）发生率和尿失禁恢复时间：共有89名患者接受了SP-RASP手术，前列腺大小中位数为110克（90-171.5），PSA水平中位数为5.5毫克/分升（2.77-10.93）。所有患者术前都至少服用了一种前列腺药物。术前评估显示，患者的国际前列腺症状评分（IPSS）中位数为23（20-27），生活质量（QoL）为4（3-5），排尿后残余物（PVR）为153毫升（60-400）。手术时间中位数为 180 分钟（164-200 分钟），估计失血量中位数为 100 毫升（30-180 毫升）。术后，没有患者需要持续膀胱冲洗。术后阿片类药物摄入量的中位数为 6.5 吗啡当量（0-10），超过 78% 的患者出院后无需使用麻醉药物。总体而言，77.5%的患者当天出院。没有记录到克拉维恩-丁多>2的并发症。中位随访时间为18（7-35）个月。在最后一次术后泌尿科评估中，中位 IPSS 为 5（3-7），QoL 为 1（0-2），PVR 为 10 毫升（0-25）。只有 4 名患者（4.5%）在术后出现尿失禁，且均在 3 个月内恢复：SP-RASP的尿失禁发生率和功能效果非常令人鼓舞，这可能是由于精确的腺瘤和尿道切除术以及膀胱颈重建术。这种方法还允许患者当天出院。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Prostate Cancer and Prostatic Diseases 医学-泌尿学与肾脏学

CiteScore

10.00

自引率

6.20%

发文量

142

审稿时长

6-12 weeks

期刊介绍： Prostate Cancer and Prostatic Diseases covers all aspects of prostatic diseases, in particular prostate cancer, the subject of intensive basic and clinical research world-wide. The journal also reports on exciting new developments being made in diagnosis, surgery, radiotherapy, drug discovery and medical management. Prostate Cancer and Prostatic Diseases is of interest to surgeons, oncologists and clinicians treating patients and to those involved in research into diseases of the prostate. The journal covers the three main areas - prostate cancer, male LUTS and prostatitis. Prostate Cancer and Prostatic Diseases publishes original research articles, reviews, topical comment and critical appraisals of scientific meetings and the latest books. The journal also contains a calendar of forthcoming scientific meetings. The Editors and a distinguished Editorial Board ensure that submitted articles receive fast and efficient attention and are refereed to the highest possible scientific standard. A fast track system is available for topical articles of particular significance.