Robotic-assisted laparoscopic simple prostatectomy: an alternative minimal invasive approach for prostate adenoma

Abstract

To substantiate robotic-assisted laparoscopic simple prostatectomy (RLSP) as an alternative minimal invasive approach for the treatment of prostatic adenoma. Retrospective chart review performed with institutional review board (IRB) approval. Demographic and clinical data were collected on 15 men between May 2007 and October 2009 who underwent RLSP for urinary retention secondary to benign prostate hypertrophy (BPH) and complicated by significant median lobe hypertrophy, bladder diverticula and/or stones. International Prostate Symptoms Score (IPSS), postvoid residual (PVR), prostate-specific antigen (PSA) and cystoscopy, urodynamics evaluation, and operative reports were reviewed and analyzed. Average age, PSA, IPSS, and PVR in the series were 65.8 years, 5.17 ng/ml, 23.85, and 265.79 ml, respectively. Eleven men (73%) had urinary retention at presentation, 93.3% had significant intravesical lobe hypertrophy, 13.3% had bladder diverticula with/without stones, and mean prostate volume was 70.85 ml. All the men complained principally of persistent lower urinary tract symptoms (LUTS) despite maximal medical treatment. Mean operative time, estimated blood loss, and adenoma weight were 128.8 min, 139.3 ml, and 46.4 g, respectively. Mean hospital stay was 2.5 days with average postoperative Foley catheter time of 4.6 days. The only significant complication in the series was a postoperative incarcerated hernia in a patient with intraoperative repair of inguinal hernia. Postoperatively, symptom score improved significantly to an average of 8.13 (P = 0.0002), and urine residual also improved to an average of 44.19 ml (P ≤ 0.0001). Significant improvement from the sequelae of BPH can be successfully achieved with RLSP.

Keywords: BPH; Prostate adenoma; Prostate median lobe hypertrophy; Robotic prostatectomy; Robotic surgery; Simple prostatectomy.