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Transvesical versus extraperitoneal single-port robotic radical prostatectomy: a matched-pair analysis

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Abstract

Objective

To compare our initial perioperative and postoperative outcomes of the single-port (SP) transvesical radical prostatectomy (TVRP) approach with the single-port extraperitoneal radical prostatectomy (ERP) approach.

Materials and methods

Initial consecutive seventy-eight patients underwent SP TVRP between December 2020 and October 2021. Patients with extensive previous abdominal surgeries, or low- to intermediate-risk prostate cancer were selected. Data of consecutive 169 patients treated with SP ERP between February 2019 and November 2020, were used for comparison. Optimal matched-paired analysis of PSA value, biopsy Gleason score, and prostate volume was performed. Preoperative, perioperative, and early functional outcomes were included in the analysis. The median follow-up was 7 months and 9 months for TVRP and ERP groups respectively.

Results

The median total operative time was longer in the TVRP compared to the ERP group (p = .002). There were no differences in intraoperative complications or surgical margin status. TVRP group had less rate of grade 3a Clavien–Dindo complications (p = .026). The Foley catheter duration was 3 (3, 4) days in the TVRP group compared to 7 (7, 8) days in the ERP group (p < .001). There was a consistently improved continence rate in the TVRP group at 6 weeks (72% TVRP, 48% ERP, p = .004), 3 months (97% TVRP, 81% ERP, p = .008), and 6 months postoperatively (100% TVRP, 93% ERP, p = .047). There was no difference in biochemical recurrence at 6 months of follow-up.

Conclusion

In our initial series, TVRP allows for a faster continence recovery, without other functional or oncological compromises.

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Abbreviations

RP:

Radical prostatectomy

SP:

Single-port

ERP:

Extraperitoneal radical prostatectomy

TVRP:

Transvesical radical prostatectomy

LND:

Lymph node dissection

BMI:

Body mass index

ASA:

American society of anesthesiologists

IQR:

Interquartile range

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Authors and Affiliations

  1. Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, Q1044195, USA

    Mahmoud Abou Zeinab, Alp Tuna Beksac, Ethan Ferguson, Aaron Kaviani & Jihad Kaouk

Authors
  1. Mahmoud Abou Zeinab
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  2. Alp Tuna Beksac
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  3. Ethan Ferguson
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  4. Aaron Kaviani
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  5. Jihad Kaouk
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Contributions

MAZ: project development, data collection, data analysis, manuscript writing/editing. ATB: data collection, manuscript writing/editing. EF: data collection. AK: data collection. JK: project development, manuscript writing/editing.

Corresponding author

Correspondence to Jihad Kaouk.

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Conflicts of interest

Jihad Kaouk, MD. Is a speaker Bureau for Intuitive Surgical Company.

Human participants and/or animals

All patients data were collected in an Institutional Review Board approved secured database.

Informed consent

All patients were consented on the radical prostatectomy procedure prior to the surgery.

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Abou Zeinab, M., Beksac, A.T., Ferguson, E. et al. Transvesical versus extraperitoneal single-port robotic radical prostatectomy: a matched-pair analysis. World J Urol 40, 2001–2008 (2022). https://doi.org/10.1007/s00345-022-04056-6

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  • DOI: https://doi.org/10.1007/s00345-022-04056-6

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