The importance of surgical access in the treatment of patients with prostate cancer and abnormal prostate anatomy

Background. The increased volume of the prostate in patients with confirmed prostate cancer (pc) is observed in 10 % of cases. The limitations of external beam radiotherapy and brachytherapy associated with large prostate volume and obstructive symptoms define radical prostatectomy (Rp) as the only possible treatment for prostate cancer in these patients. The purpose of the study was to determine the importance of the surgical approach in radical prostatectomy in patients with abnormal anatomy of the prostate. Material and methods. The study group consisted of patients with a prostate volume of more than 80 cm3 (n=40) who underwent a robot prostatectomy. The comparison group was represented by patients also selected by the prostate volume ≥ 80 cm3, who underwent classical open prostatectomy (n=44). The groups were comparable in age and psa level. The average prostate volume in the study group was 112.2 ± 26 cm 3(80–195 cm 3). The average prostate volume in the comparison group was 109.8 ± 18.7 cm3 (80–158 cm 3) (р>0.05). Both groups had favorable morphological characteristics. Results. The average surgery time difference was 65 minutes in favor of the open prostatectomy (p<0.05). The average blood loss volume in the study group was 282.5 ± 227.5 ml (50–1000 ml). The average blood loss volume in the group with open prostatectomy was 505.7 ± 382.3 ml (50–2000 ml). Positive surgical margin in the robotic prostatectomy was not detected, at 6.9 % in the group with open prostatectomy (p<0.05). According to the criterion of urinary continence, the best results were obtained in the group of robotic prostatectomy (p<0.05). Overall and relapse-free 5-year survival did not show a statistically significant difference. Conclusion. The use of robotic prostatectomy in a group of patients with a large prostate volume (≥ 80 cm3) allows us to achieve better functional and oncological outcomes.

Development of a Leaking Urachal Fistula in A BPH Patient with Recurrent Acute Urinary Retention: A Case Report

FE is a 65yr old retired civil servant who developed lower urinary tract symptoms associated with recurrent acute urinary retentions relieved each time by urethral catheterization. In one episode he started leaking urine from the umbilicus. A fistulogram outlined an irregular fistulous cavity in the lower anterior abdominal wall. Patient had excision of the fistulous tract and communication with bladder sealed. He had uneventful post operative recovery and is being worked up for open simple prostatectomy for his large prostate.

Functional and Oncological Outcomes Following Robot-Assisted and Laparoscopic Radical Prostatectomy for Localized Prostate Cancer With a Large Prostate Volume: A Retrospective Analysis With Minimum 2-Year Follow-Ups

ObjectiveWe aimed to analyze the perioperative, functional, and oncologic outcomes following robot-assisted radical prostatectomy (RARP) and laparoscopic radical prostatectomy (LRP) for patients with localized prostate cancer (PCa) characterized by a large prostate volume (PV; ≥50 ml) over a minimum of 2 years follow-up.Materials and MethodsPatients undergoing RARP and LRP for localized PCa with a large PV were included in the final analysis. The perioperative, functional, and oncologic outcomes were analyzed between the two groups.ResultsAll operations were successfully completed without open conversion in both groups. The mean operative time and estimated blood loss in the RARP group were significantly decreased compared to those in the LRP group (139.4 vs. 159.0 min, p = 0.001, and 124.2 vs. 157.3 ml, p = 0.003, respectively). Patients in the RARP arm had significantly lower proportions of grade II or lower and of higher than grade II postoperative complications compared with those in the LRP group (7.9% vs. 17.1%, p = 0.033, and 1.6% vs. 6.7%, p = 0.047, respectively). No significant differences in terms of the rates of pT3 disease, positive surgical margin, and positive lymph node were noted between the two groups. Moreover, no significant difference in the median specimen Gleason score was observed between the RARP and LRP groups (6 vs. 7, p = 0.984). RARP vs. LRP resulted in higher proportions of urinary continence upon catheter removal (48.4% vs. 33.3%, p = 0.021) and at 3 (65.1% vs. 50.5%, p = 0.025) and 24 (90.5% vs. 81.0%, p = 0.037) months post-operation. The median erectile function scores at 6 and 24 months post-operation in the RARP arm were also significantly higher than those in the LRP arm (15 vs. 15, p = 0.042, and 15 vs. 13, p = 0.026, respectively). Kaplan–Meier analyses indicated that the biochemical recurrence-free survival and accumulative proportion of continence were statistically comparable between the two groups (p = 0.315 and p = 0.020, respectively).ConclusionsFor surgically managing localized PCa with a large prostate (≥50 ml), RARP had a tendency toward a lower risk of postoperative complications and better functional preservation without cancer control being compromised when compared to LRP.

Robotic-Assisted vs. Open Simple Prostatectomy for Large Prostates: A Meta-Analysis

Purpose: To compare the efficacy and safety of robotic-assisted simple prostatectomy and open simple prostatectomy for large benign prostatic hyperplasia.Methods: We systematically searched the Cochrane Library, PubMed, Embase, and Science databases for studies published through December 2020. Controlled trials on RASP and OSP for large prostates were included. The meta-analysis was conducted with the Review Manager 5.4 software.Results: A total of seven studies with 3,777 patients were included in the analysis. There were no significant differences in IPSS (WMD, 0.72; 95%CI: −0.31, 1.76; P = 0.17), QoL (WMD, 0.00; 95%CI: −0.39, 0.39; P &gt; 0.99), Qmax (WMD, 1.88; 95% CI: −1.15, 4.91; P = 0.22), or PVR (WMD, −10.48; 95%CI: −25.13, 4.17; P = 0.16) among patients undergoing RASP and OSP. However, compared with patients who underwent OSP, patients who underwent RASP had a shorter LOS (WMD, −2.83; 95%CI: −3.68, −1.98; P &lt; 0.001), less EBL (WMD, −304.68; 95% CI: −432.91, −176.44; P &lt; 0.001), a shorter CT (WMD, −2.61; 95%CI: −3.94, −1.29; P &lt; 0.001), and fewer overall complications (OR, 0.30; 95% CI: 0.16, 0.57; P &lt; 0.001). Nevertheless, RASP was associated with a longer OT (WMD, 59.69, 95% CI: 49.40, 69.98; P &lt; 0.001).Conclusion: The results of the current study demonstrated that RASP provided similar efficacy to those of OSP in the treatment of large prostate, while maintaining better security. Our findings indicate that RASP is a feasible and effective alternative to OSP.