Transvesical robot-assisted radical prostatectomy for recalcitrant bladder neck contracture after holmium laser enucleation of prostate: initial experience and clinical outcomes.

Abstract

Purpose: To evaluate the feasibility and clinical efficacy of transvesical robotic assisted radical prostatectomy (TvRARP) for the treatment of recurrent recalcitrant bladder neck contracture (rBNC) after holmium laser enucleation of prostate (HoLEP).

Methods: In this retrospective study, 8 patients diagnosed with rBNC were enrolled for TvRARP. The patients' preoperative data median age: 73 years (Interquartile range (IQR) 72-74), median body mass index (BMI): 29.8 kg/m² (IQR 20.5-31.5), median prostate volume: 29 ml (IQR 25-45.3), median peak urinary flow (Qmax): 4.15 ml/s (IQR 3.65-4.35), median post-void residual urine (PVR): 190 ml (IQR 145-220), median International Prostate Symptom Score (IPSS): 31 (IQR 29.8-32.5), and median quality of life (QoL): 5 (IQR 5-6) were collected. All patients were excluded from prostate tumors through PSA testing or magnetic resonance imaging (MRI). The surgical outcomes and perioperative complications were evaluated. All patients received follow-up for a minimum of 6 months postoperatively, and their post-operative data were subsequently collected and analyzed.

Results: The median surgical time was 123 min (IQR 119-130), and the median intraoperative blood loss was 50 ml (IQR 50-62.5). The median hospital stay was 7.5 days (IQR 7-8). No severe intraoperative complications occurred, nor did any major postoperative complications arise. All patients achieved continence at postoperative 3 months. All patients achieved treatment success, as evidenced by the successful passage of a 17Fr cystoscope into the bladder or a postoperative uroflow rate exceeding 15 ml/sec. At the 6-month postoperative assessment, the Qmax significantly improved from 4.15 ml/s (IQR 3.65-4.35) to 17.7 ml/s (IQR 17.5-18.6) (p < 0.05). The PVR notably reduced from 190 ml (IQR 145-220) to 17.5 ml (IQR 13.8-36.3) (p < 0.05). The IPSS improved significantly postoperatively, decreasing from 31 (IQR 29.8-32.5) to 10.5 (IQR 9.8-12) (p < 0.05), while the QoL score improved dramatically from 5 (IQR 5-6) to 1 (IQR 1-1) (p < 0.001). Additionally, the OAB-V8 score demonstrated significant improvement after the surgery, decreasing from 17 (IQR 11.8-23.5) to 7.5 (IQR 6.8-9.5) (p < 0.05).

Conclusion: TvRARP is a valid and safe alternative for the treatment of rBNC with an acceptable risk of intraoperative and postoperative complications. It also is a reasonable approach providing promising success rates and continence outcomes. Long-term functional results require further investigation.