-
Nigerian Journal of Clinical Practice Sep 2023Open prostatectomy (OP) is still a valid treatment option for benign prostatic hyperplasia (BPH), but it needs to be constantly reevaluated in the context of minimally...
BACKGROUND
Open prostatectomy (OP) is still a valid treatment option for benign prostatic hyperplasia (BPH), but it needs to be constantly reevaluated in the context of minimally invasive treatments (MITs).
AIM
Our purpose is to present contemporary data on patient presentation and surgical outcomes of OP with which other OP series and MITs can be compared.
METHODS
A retrospective study of all OP was carried out in our institution from January 2011 to December 2020. All patients had a thorough preoperative workup and optimization of comorbidities before surgery. Data were collected in a predesigned pro forma and analyzed.
RESULTS
The mean age of the 148 patients studied was 66.2 (±7.9) yrs. The mean duration of symptoms before surgery was 32.2 (±33.7) mos. The mean preoperative prostate volume was 118.0 (±67.1) cm. There was a 54.4% comorbidity rate with diabetes mellitus (DM) topping the list (16.0%). An incidental prostate cancer rate of 6.1% was found. The overall complication rate was 45.3%. Perioperative hemorrhage requiring blood transfusion (BT) was the most common complication (26.1%). There was no significant difference in age, duration of surgery, and prostrate volume between subjects with and without BT (P > 0.05). Wound infection was significantly associated with diabetes (P = 0.043, OR = 3.507, 95% CI = 1.042-11.805). The reoperation rate was 1.4%, and mortality rate was 0.7%. The International Prostate Symptom Score (IPSS), quality-of-life (QOL) score, and post-void residual urine (PVR) volume were significantly improved (P < 0.001).
CONCLUSION
OP was found to be a safe and effective procedure for the relief of bladder outlet obstruction (BOO) secondary to BPH. However, it was associated with high morbidity and low reoperation rate.
Topics: Male; Humans; Middle Aged; Aged; Prostatic Hyperplasia; Retrospective Studies; Quality of Life; Prostatectomy; Treatment Outcome
PubMed: 37794546
DOI: 10.4103/njcp.njcp_55_23 -
Chirurgia (Bucharest, Romania : 1990) 2018Retroperitoneal Laparoscopic Radical Prostatectomy (RLRP) has been introduced in our department as the first line treatment for patients with localized prostatic cancer...
Retroperitoneal Laparoscopic Radical Prostatectomy (RLRP) has been introduced in our department as the first line treatment for patients with localized prostatic cancer and life expectancy over 10 years. At the time, the surgical team had already extensive experience in minimally invasive urologic surgery. Our aim is to describe the laparoscopic technique we currently use and to analyze our oncologic and functional results. Patients and All the patients who underwent RLRP in our institution (PONDERAS ACADEMIC HOSPITAL) from January 2015 to March 2017 were included into a prospective study. The standard preoperative protocol included blood tests, prostate biopsy, pelvis MRI and bone scintigraphy, while the particular therapy was discussed and approved by the Institutional Multidisciplinary Tumor Board. In all the 45 cases, RLRP was indicated for localized prostate cancer. The average patientâÃÂÃÂs age was 68 years (range 45 âÃÂ" 74 years), mean preoperative prostate specific antigen (PSAi) level was 8 ng/mL (range 3âÃÂ"15 ng/mL) and prostatic volume between 26 and 52 cc. The laparoscopic approach was completed in all 45 cases âÃÂ" no conversions to open surgery. Bilateral nerve sparing was performed in 7 cases (16%) and unilateral in 23 cases (51%). The mean operative time was 165 minutes (range 120 - 240 min), while the average blood loss was 255 mL (range 20âÃÂ"800) and two patients received blood transfusions. The mean catheterization time was 10 days (range 7âÃÂ"14 days). Positive surgical margins were observed in 8 cases (17.7%). Overall, 86% and respectively, 93% of the patients were continent during the following 3 and 6 months. 51% of the patients had erectile disfunction 6 month after the intervention. Four complications were encountered: intraoperatively - rectal injury (1 case) and postoperatively - bleeding (2 cases) and stenosis at the vesicourethral anastomosis (1 case). No mortality or late morbidity encountered. The radical laparoscopic prostatectomy is a safe and efficient procedure for localized prostate cancer with minimal complications and short hospitalization time, but it requires an experienced team of laparoscopic surgeons. The functional and oncological outcomes of LRP are expected to be improved as the medical team experience is extended.
Topics: Aged; Humans; Laparoscopy; Male; Middle Aged; Prospective Studies; Prostatectomy; Prostatic Neoplasms; Retroperitoneal Space; Treatment Outcome
PubMed: 30183585
DOI: 10.21614/chirurgia.113.4.542 -
Journal of Endourology Aug 2016We compared the cost-effectiveness of laparoscopic simple prostatectomy (LSP) vs open prostatectomy (OP). (Comparative Study)
Comparative Study
INTRODUCTION
We compared the cost-effectiveness of laparoscopic simple prostatectomy (LSP) vs open prostatectomy (OP).
PATIENTS AND METHODS
A total of 73 men treated for benign prostatic hyperplasia were enrolled for OP and LSP in groups 1 and 2, respectively. The findings were recorded perioperative, including operation time (OT), blood lost, transfusion rate, conversion to the open surgery, and the complications according to the Clavien Classification. The postoperative findings, including catheterization and drainage time, the amount of analgesic used, hospitalization time, postoperative complications, international prostate symptom score (IPSS) and International Index of Erectile Function (IIEF) scores, the extracted prostate weight, the uroflowmeter, as well as postvoiding residual (PVR) and quality of life (QoL) score at the postoperative third month, were analyzed. The cost of both techniques was also compared statistically.
RESULTS
No statistical differences were found in the preoperative parameters, including age, IPSS and QoL score, maximum flow rate (Qmax), PVR, IIEF score, and prostate volumes, as measured by transabdominal ultrasonography. No statistical differences were established in terms of the OT and the weight of the extracted prostate. No differences were established with regard to complications according to Clavien's classification in groups. However, the bleeding rate was significantly lower in group 2. The drainage, catheterization, and hospitalization times and the amount of analgesics were significantly lower in the second group. The postoperative third month findings were not different statistically. Only the Qmax values were significantly greater in group 2. While there was only a $52 difference between groups with regard to operation cost, this difference was significantly different.
CONCLUSION
The use of LSP for the prostates over 80 g is more effective than the OP in terms of OT, bleeding amount, transfusion rates, catheterization time, drain removal time, hospitalization time, consumed analgesic amount, and Qmax values. On the other hand, the mean cost of the LSP is higher than OP. Better effectiveness comes with higher cost.
Topics: Aged; Blood Loss, Surgical; Blood Transfusion; Conversion to Open Surgery; Erectile Dysfunction; Follow-Up Studies; Health Care Costs; Humans; Laparoscopy; Male; Middle Aged; Operative Time; Organ Size; Postoperative Complications; Prostatectomy; Prostatic Hyperplasia; Quality of Life; Retrospective Studies; Time Factors; Urinary Catheterization; Urinary Retention
PubMed: 27189387
DOI: 10.1089/end.2016.0261 -
Urologia Internationalis 2016To assess clinical outcomes and reimbursement costs of open and robotic-assisted radical prostatectomies in Germany. (Comparative Study)
Comparative Study
PURPOSE
To assess clinical outcomes and reimbursement costs of open and robotic-assisted radical prostatectomies in Germany.
METHODS
Perioperative data of 499 open (2003-2006) and 932 (2008-2010) robotic-assisted radical prostatectomies as well as longitudinal reimbursement costs of an anonymized health insurance research database from Germany containing data of patients who underwent robotic-assisted or open radical prostatectomy were retrospectively analysed in a single-centre study.
RESULTS
Significantly better outcomes after robotic-assisted vs. open prostatectomy were observed in regards to positive surgical margins (13.3 vs. 22.4%; p < 0.0001), intraoperative transfusions (0.1 vs. 2.6%; p < 0.0001), hospitalization (8.7 vs. 15.2 days; p < 0.0001) and duration of catheter (6.6 vs. 12.8 days; p < 0.0001). Operating time was significantly longer with robotic-assisted radical prostatectomy when compared to open surgery (184.4 vs. 128.0 min; p < 0.0001), while intraoperative complications showed a similar occurrence between both groups. Significant fewer postoperative complications were observed after robotic-assisted radical prostatectomy (26.5 vs. 42.5%; p < 0.0001) and rate of re-admission was lower for the robotic patients (13.6 vs. 19.4%; p = 0.0050). While insurance costs were higher in the 2 years before radical prostatectomy for the patients who underwent a robotic procedure (4,241.60 vs. 3,410.23 €; p = 0.202), additive costs of care of the year of surgery plus the 2 following years were less for the robotic cohort when compared to the costs incurred by the open group (21,673.71 vs. 24,512.37 €; p = 0.1676).
CONCLUSIONS
The observed clinical advantages of robotic-assisted radical prostatectomy seem to result in reduced health insurance cost postoperatively when compared to open surgery. This should be taken into consideration regarding reimbursement and implementation of a clinically superior method.
Topics: Aged; Catheterization; Germany; Health Care Costs; Humans; Insurance, Health; Intraoperative Period; Laparoscopy; Length of Stay; Male; Middle Aged; Operative Time; Perioperative Period; Postoperative Complications; Prostate; Prostatectomy; Prostatic Neoplasms; Retrospective Studies; Robotic Surgical Procedures; Treatment Outcome
PubMed: 26159050
DOI: 10.1159/000431104 -
World Journal of Urology Jul 2021Robotic-assisted simple prostatectomy (RASP) has recently been studied as an alternative to open simple prostatectomy or endoscopic treatment options. At present, there... (Review)
Review
PURPOSE
Robotic-assisted simple prostatectomy (RASP) has recently been studied as an alternative to open simple prostatectomy or endoscopic treatment options. At present, there is no defined recommendation for a robotic procedure as a standard surgical technique to treat large benign prostate hyperplasia.
METHODS
Several robotic techniques have been described since 2007. Contemporaneously, multiple endoscopic enucleation techniques have been proposed. Nevertheless, open simple prostatectomy still remains a mainstay of therapy. We aimed to evaluate the development of robotic-assisted prostatectomy for large benign prostatic obstruction, thus comparing the technical aspects and clinical outcomes with open and endoscopic enucleation.
RESULTS
Robotic-assisted simple prostatectomy provides significantly less blood loss and shorter hospital stay but longer operative time compared to open simple prostatectomy. Compared to endoscopic treatments, robotic approaches have a similar perioperative outcome, but cause less urethral trauma or potential bladder neck strictures. Moreover, concomitant bladder pathologies can be treated within the same setting.
CONCLUSION
Robotic-assisted simple prostatectomy is an effective and safe technique, and can hence be considered to become the preferred first-line therapy to treat patients with obstructive large prostate glands.
Topics: Humans; Male; Organ Size; Prostatectomy; Prostatic Hyperplasia; Robotic Surgical Procedures
PubMed: 33575813
DOI: 10.1007/s00345-020-03508-1 -
Acta Clinica Croatica Oct 2022Radical prostatectomy (RP) performed by open, laparoscopic, or robotic approach is considered the gold standard for localized prostate cancer (PCa). However, it carries... (Review)
Review
Radical prostatectomy (RP) performed by open, laparoscopic, or robotic approach is considered the gold standard for localized prostate cancer (PCa). However, it carries the risk of postprostatectomy urinary incontinence (UI) and erectile dysfunction (ED) which significantly reduce patients' satisfaction with surgery and quality of life (QoL), therefore it is important to decrease the possibility or severity of these complications to a minimum. There are several preoperative prognostic factors such as urethral length and closing pressure obtained by magnetic resonance imaging and profilometry, as well as several variations in the surgical approach such as preservation of the neurovascular bundle (NVB) and puboprostatic ligaments, sparing or reconstruction of bladder neck, Retzius-sparing approach, and meticulous surgical dissection, used to predict or prevent unwanted side effects of RP. In addition, there are postoperative methods that can help reduce complications. In this review, we will present the role of pelvic rehabilitation with an emphasis on pelvic floor muscle training (PFMT) in reducing consequences of radical surgery.
Topics: Male; Humans; Quality of Life; Prostatectomy; Urinary Incontinence; Urinary Bladder; Erectile Dysfunction; Prostatic Neoplasms
PubMed: 36938558
DOI: 10.20471/acc.2022.61.s3.10 -
World Journal of Urology Sep 2016To evaluate the efficacy and safety of transurethral enucleation of the prostate (TUEP) versus transvesical open prostatectomy (OP) for the management of large benign... (Comparative Study)
Comparative Study Meta-Analysis Review
Transurethral enucleation of the prostate versus transvesical open prostatectomy for large benign prostatic hyperplasia: a systematic review and meta-analysis of randomized controlled trials.
PURPOSE
To evaluate the efficacy and safety of transurethral enucleation of the prostate (TUEP) versus transvesical open prostatectomy (OP) for the management of large benign prostatic hyperplasia (BPH).
METHODS
Randomized controlled trials (RCTs) comparing TUEP and OP were identified from PubMed, Embase and Web of Science up to February 28, 2015. A meta-analysis was conducted with the STATA 12.0 software.
RESULTS
Nine RCTs including 758 patients were enrolled in our meta-analysis. There were no significant differences between the two groups in the maximum urinary flow rate at 1, 3, 6 months, 1 and 2 years: postvoiding residual urinary volume, prostate-specific antigen, international prostate symptom score and quality of life score at 1, 3, 6 months and 1 year; or international index of erectile function at 3, 6 months and 1 year. Perioperative outcomes including hemoglobin level drop, catheter period, irrigation length and hospital stay favored TUEP, while operative time and resected prostate weight favored OP. There was significantly less blood transfusion with TUEP, but no significant differences were found in other complications such as recatheterization, urinary tract infection, reintervention for clots and bleeding control, incidence of pneumonia and infarction, transient incontinence, bladder neck contracture, urethral stricture and recurrent adenoma.
CONCLUSIONS
TUEP can be performed effectively and safely with functional outcomes and complications similar to OP for large BPH, whereas it has the advantages of a shorter catheter period, shorter hospital stays and less blood transfusion. These findings seem to support TUEP as the next-generation "gold standard" of surgery for large BPH.
Topics: Humans; Male; Prostatectomy; Prostatic Hyperplasia; Randomized Controlled Trials as Topic; Urethra; Urinary Bladder
PubMed: 26699627
DOI: 10.1007/s00345-015-1735-9 -
Lasers in Medical Science Aug 2021The benefit of transurethral laser prostatectomy over open simple prostatectomy (OSP) is controversial in aged symptomatic benign prostatic hyperplasia (BPH) patients... (Comparative Study)
Comparative Study Meta-Analysis
The benefit of transurethral laser prostatectomy over open simple prostatectomy (OSP) is controversial in aged symptomatic benign prostatic hyperplasia (BPH) patients with large volume prostates, and the aim of this study is to compare the safety and efficiency of these two methods. Meta-analysis was applied using the Review Manager V5.3 software and the retrieved randomized controlled clinical trials (RCTs) comparing transurethral laser prostatectomy with OSP were analyzed for the treatment of large volume prostates from 2000 to 2019 in PubMed, Web of Science, Cochrane, and EMBASE datasets. Five RCTs assessing transurethral laser prostatectomy versus OSP were considered suitable for this meta-analysis, which included a total of 448 patients, with 232 patients undergoing laser and 216 patients undergoing OSP. Compared with OSP, although transurethral laser prostatectomy required a longer operative time (weighted mean difference (WMD) 27.49 mins; 95% confidence interval (CI) 16.54-38.44; P < 0.00001) and obtained a less resected prostate weight (WMD - 11.72 g; 95% CI - 21.75 to - 1.70; P = 0.02), patients undergoing laser prostatectomy benefited from significantly less hemoglobin decline (- 0.97 g/dL; 95% CI - 1.31 to - 0.64; P < 0.00001), shorter time of catheterization (WMD - 3.67 days; 95% CI - 5.60 to - 1.75; P = 0.0002), shorter length of hospital stay (WMD - 4.75 days; 95% CI - 6.57 to - 2.93; P < 0.00001), and less blood transfusion (odds ratio 0.10; 95% CI 0.03 to 0.35; P = 0.0003). During postoperative follow-up, no significant difference was observed between the two groups in IPSS, QoL, Q, and PVR. Both transurethral laser prostatectomy and OSP are safe and effective for large prostates that require prostate resection. Taking into account of less blood loss, shorter catheterization time and hospital stay, and less blood transfusion, transurethral laser prostatectomy may be a better treatment for patients with large prostates.
Topics: Humans; Male; Organ Size; Prostate; Prostatectomy; Prostatic Hyperplasia; Randomized Controlled Trials as Topic; Transurethral Resection of Prostate
PubMed: 33044648
DOI: 10.1007/s10103-020-03153-5 -
JAMA Network Open Aug 2021
Topics: Humans; Laparoscopy; Male; Prostate; Prostatectomy; Robotic Surgical Procedures; Robotics
PubMed: 34432015
DOI: 10.1001/jamanetworkopen.2021.20693 -
Urology Aug 2018To assess long-term reoperation rates and mortality after transurethral resection of the prostate (TURP) and open prostatectomy (PE) as therapy for lower urinary tract... (Comparative Study)
Comparative Study
OBJECTIVE
To assess long-term reoperation rates and mortality after transurethral resection of the prostate (TURP) and open prostatectomy (PE) as therapy for lower urinary tract symptoms due to benign prostatic enlargement.
METHODS
The present study analyzes a nationwide database of all patients who underwent TURP/open PE during 2002-2006 and who were followed up for 8 years. Actuarial cumulative incidences of reoperation (TURP, urethrotomy, bladder neck incision) and death were calculated. Data were provided by the Austrian Public Health Institute. This series was compared with a previously published almost equally sized nationwide cohort that underwent surgery during 1992-1996 in Austria.
RESULTS
Between 2002 and 2006, a total of 21,674 patients underwent TURP (n = 20,388) or open PE (n = 1,286). At 8 years, the re-TURP rate after primary TURP was 8.3% vs 4.3% after open PE. The re-TURP rate was higher in the 80+ cohort. The overall endourological reintervention rate at 8 years was 12.7% for TURP and 8.8% for open PE. Reintervention rates did not improve compared with the 1992-1996 series. The 30-day in-hospital mortality rate was 0.1% for TURP and 0.2% for open PE. Mortality rates improved by approximately 20% compared with the 1992-1996 series.
CONCLUSION
In Austria, TURP rates remained stable between 1992 and 2006, paralleled by a 50% decline of open PE. Within a decade, mortality rates declined by 20%, yet reintervention rates remained unchanged.
Topics: Aged; Aged, 80 and over; Austria; Humans; Lower Urinary Tract Symptoms; Male; Middle Aged; Mortality; Prostatectomy; Prostatic Hyperplasia; Reoperation; Time Factors; Transurethral Resection of Prostate
PubMed: 29733869
DOI: 10.1016/j.urology.2018.04.032