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Translational Andrology and Urology Apr 2020Several studies have assessed the safety and feasibility of single port robot-assisted radical prostatectomy using different and custom built robotic-assisted... (Review)
Review
Several studies have assessed the safety and feasibility of single port robot-assisted radical prostatectomy using different and custom built robotic-assisted technology. In part due to the non-standardized nature of these approaches, single site robotic prostatectomy has not been widely adopted. With the recent approval of the da Vinci (Intuitive Surgical, Sunnyvale CA) Single Port (SP) platform, there has been a renewed interest in single site robotic-assisted prostatectomy and several institutions have begun reporting their initial experiences with this technique. In this systematic review, we sought to assess and summarize the literature regarding patient outcomes for single site robotic-assisted prostatectomy and evaluate its role in surgical treatment of prostate cancer. This systematic review was structured using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies describing the use of any robotic platform, including da Vinci Si, Xi or SP platforms for robotic single-port or single site radical prostatectomy between 2000 and July 15, 2019 were eligible for inclusion in this systematic review. Studies were excluded if they included combined cases with other organ resection, represented use in a non-clinical setting (such as a cadaveric model), or described results for a simple prostatectomy technique. Data was extracted by two authors with concerns resolved by consensus. Primary outcomes were mean operative times, estimated blood loss (mL), and hospital length of stay (days). Secondary outcomes included intraoperative conversion to open surgery, and intraoperative and postoperative complications. Variables of interest included sample size (n), mean age (years), mean prostate size (mL), prostate specific antigen (PSA, ng/mL), Gleason score, clinical and pathological TNM staging [American Joint Commission on Cancer (AJCC)], lymph nodes (n) and perioperative complications as available. A total of 217 studies were reviewed by title and abstract, with 28 selected for full-text review; ultimately, 12 studies were included, with available data from 145 patients. Primary outcomes and preoperative characteristics varied greatly amongst patients and across studies. One patient (0.7%) required conversion to a multi-port approach and there were no conversions to an open technique. No intraoperative complications were reported, and no Clavien grade III or greater postoperative complications have been described in the initial 81 radical prostatectomies performed with the SP platform. Single Port techniques appear to represent a safe and feasible approach for performing the minimally invasive radical prostatectomy. The current available literature on the single port radical prostatectomy is weak and consists of single center studies with small sample sizes, short-term follow up and limited functional data. More rigorous multi-center trials with standardized metrics for reporting functional outcomes as well as long-term cancer specific survival are necessary to validate these initial studies.
PubMed: 32420205
DOI: 10.21037/tau.2019.11.05 -
Urology Research & Practice Jan 2024Prostate cancer is the second- leading cause of cancer death among men. We aimed to evaluate high-intensity focused ultrasound (HIFU), open radical prostatectomy (ORP),...
OBJECTIVE
Prostate cancer is the second- leading cause of cancer death among men. We aimed to evaluate high-intensity focused ultrasound (HIFU), open radical prostatectomy (ORP), robot-assisted radical prostatectomy (RARP), and external beam radiation therapy (RT) in the treatment of localized low- and intermediate-risk prostate cancer.
METHODS
We searched bibliographic databases for case-control, cohort, and randomized controlled studies. We used MeSH subject headings and free text terms for prostate cancer, HIFU, ORP, RARP, RT, failure-free survival (FFS), biochemical disease-free survival (BDFS), urinary incontinence (UI), and erectile dysfunction (ED).
RESULTS
Fourteen studies were included in the review, for a total of 34 927 participants. Among the 8 studies of HIFU as the primary treatment of localized low- and intermediate- risk prostate cancer, 4 studies reported 5-year FFS rates ranging from 67.8% to 97.8%, 3 studies reported 5-year BDFS ranging from 58% to 85.4%, 5 studies reported 1-year UI rates ranging from 0% to 6%, and 4 studies reported 1-year ED rates ranging from 11.4% to 38.7%. Furthermore, our search revealed a 5-year FFS benefit favoring ORP compared to RT, a 1-year UI rate favoring ORP compared to RARP, and a 1-year ED rate favoring ORP compared to RARP.
CONCLUSION
Our systematic review and meta-analysis revealed lack of studies with active comparators comparing HIFU to standard of care (ORP, RARP, or RT) in primary treatment of localized low- and intermediate-risk prostate cancer. Open radical prostatectomy has favorable efficacy outcomes compared to RT, while RARP has beneficial functional outcomes compared to ORP, respectively.
PubMed: 38451125
DOI: 10.5152/tud.2024.23123 -
Investigative and Clinical Urology Nov 2021To review safety and efficacy of robotic-assisted simple prostatectomy (RASP) compared to open simple prostatectomy (OP). (Meta-Analysis)
Meta-Analysis
PURPOSE
To review safety and efficacy of robotic-assisted simple prostatectomy (RASP) compared to open simple prostatectomy (OP).
MATERIALS AND METHODS
A comprehensive literature search was performed to assess the differences in perioperative course and functional outcomes in patients with benign prostatic hyperplasia and surgical indication. The incidences of complications were pooled using the Cochran-Mantel-Haenszel Method and expressed as odds ratio (OR), 95% confidence interval (CI), and p-values. Perioperative course and functional outcomes were pooled using the inverse variance of the mean difference (MD), 95% CI, and p-values. Analyses were two-tailed and the significance was set at p<0.05.
RESULTS
Eight studies were accepted. Meta-analysis showed significantly longer surgical time (MD, 43.72; 95% CI, 30.57-56.88; p<0.00001) with a significantly lower estimated blood loss (MD, -563.20; 95% CI, -739.95 to -386.46; p<0.00001) and shorter postoperative stay (MD, -2.85; 95% CI, -3.72 to -1.99; p<0.00001) in RASP. Catheterization time did not differ (MD, 0.65; 95% CI, -2.17 to 3.48; p=0.65). The risk of blood transfusion was significantly higher in OP (OR, 0.23; 95% CI, 0.17-0.33; p<0.00001). The risk of recatheterization (OR, 1.96; 95% CI, 0.32-11.93; p=0.47), postoperative urinary infections (OR, 0.89; 95% CI, 0.23-3.51; p=0.87) and 30-day readmission rate (OR, 0.96; 95% CI, 0.61-1.51; p=0.86) did not differ. At 3-month follow-up, functional outcomes were similar.
CONCLUSIONS
RASP demonstrated a better perioperative outcome and equal early functional outcomes as compared to OP. These findings should be balanced against the longer operative time and higher cost of robotic surgery.
Topics: Comparative Effectiveness Research; Cost-Benefit Analysis; Humans; Male; Operative Time; Postoperative Complications; Prostatectomy; Prostatic Hyperplasia; Recovery of Function; Robotic Surgical Procedures
PubMed: 34729963
DOI: 10.4111/icu.20210297 -
Frontiers in Endocrinology 2023Surgical treatment is important for male lower urinary tract symptom (LUTS) management, but there are few reviews of the risks of reoperation. (Meta-Analysis)
Meta-Analysis
CONTEXT
Surgical treatment is important for male lower urinary tract symptom (LUTS) management, but there are few reviews of the risks of reoperation.
OBJECTIVE
To systematically evaluate the current evidence regarding the reoperation rates of surgical treatment for LUTS in accordance with current recommendations and guidelines.
EVIDENCE ACQUISITION
Eligible studies published up to July 2023, were searched for in the PubMed (National Library of Medicine, Bethesda, MD, USA), Embase (Elsevier, Amsterdam, the Netherlands), and Web of Science™ (Clarivate™, Philadelphia, PA, USA) databases. STATA (StataCorp LP, College Station, TX, USA) software was used to conduct the meta-analysis. Random-effects models were used to calculate the pooled incidences (PIs) of reoperation and the 95% confidence intervals (CIs).
EVIDENCE SYNTHESIS
A total of 119 studies with 130,106 patients were included. The reoperation rate of transurethral resection of the prostate (TURP) at 1, 2, 3, and 5 years was 4.0%, 5.0%, 6.0%, and 7.7%, respectively. The reoperation rate of plasma kinetic loop resection of the prostate (PKRP) at 1, 2, 3, and 5 years was 3.5%, 3.6%, 5.7%, and 6.6%, respectively. The reoperation rate of holmium laser enucleation of the prostate (HoLEP) at 1, 2, 3, and 5 years was 2.4%, 3.3%, 5.4%, and 6.6%, respectively. The reoperation rate of photoselective vaporization of the prostate (PVP) at 1, 2, 3, and 5 years was 3.3%, 4.1%, 6.7%, and 7.1%, respectively. The reoperation rate of surgery with AquaBeam at 1, 2, 3, and 5 years was 2.6%, 3.1%, 3.0%, and 4.1%, respectively. The reoperation rate of prostatic artery embolization (PAE) at 1, 2, 3, and 5 years was 12.2%, 20.0%, 26.4%, and 23.8%, respectively. The reoperation rate of transurethral microwave thermotherapy (TUMT) at 1, 2, 3, and 5 years was 9.9%, 19.9%, 23.3%, and 31.2%, respectively. The reoperation rate of transurethral incision of the prostate (TUIP) at 5 years was 13.4%. The reoperation rate of open prostatectomy (OP) at 1 and 5 years was 1.3% and 4.4%, respectively. The reoperation rate of thulium laser enucleation of the prostate (ThuLEP) at 1, 2, and 5 years was 3.7%, 7.7%, and 8.4%, respectively.
CONCLUSION
Our results summarized the reoperation rates of 10 surgical procedures over follow-up durations of 1, 2, 3, and 5 years, which could provide reference for urologists and LUTS patients.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO, identifier CRD42023445780.
Topics: United States; Humans; Male; Prostatic Hyperplasia; Transurethral Resection of Prostate; Prostate; Reoperation; Embolization, Therapeutic; Lower Urinary Tract Symptoms
PubMed: 38027158
DOI: 10.3389/fendo.2023.1287212 -
BJU International Jul 2024To apply a new evidence-gathering methodology, called reverse systematic review (RSR), to analyse the influence of different continence classification criteria on... (Review)
Review
OBJECTIVES
To apply a new evidence-gathering methodology, called reverse systematic review (RSR), to analyse the influence of different continence classification criteria on urinary continence rates among open retropubic radical prostatectomy (RRP), laparoscopic RP (LRP) and robot-assisted RP (RARP).
MATERIALS AND METHODS
A search was carried out in eight databases between 2000 and 2020 through systematic reviews (SRs) studies referring to RRP, LRP or RARP (80 SRs). All references used in these SRs were captured referring to 910 papers in an overall database called the 'EVIDENCE Database'. A total of 422 studies related to post-RP urinary continence were selected for the final analysis, totalling 782 reports referring to 193 618 patients.
RESULTS
Overall, 206 (26.4%) reports for RRP, 243 (31.0%) reports for LRP, and 333 (42.6%) reports for RARP were found. Mean overall continence rates, respectively for RRP, LRP and RARP, were: 42%, 34% and 42% at 1 month; 62%, 64% and 65% at 3 months; 73, 77 and 79% at 6 months; and 81%, 85% and 86% at 12 months. The most used criterion was 'No pad' (53.3%), followed by 'Safety pad' (19.3%), 'Not described' (10.6%), and 'No leak' (9.9%). 'No pad' showed the lowest discrepancy in continence rates in each period compared to the overall average for each technique, demonstrating less ability to influence the final results favouring any of the techniques.
CONCLUSION
The RSR demonstrated that the 'No pad' criterion was the most used in the literature and showed the lowest bias capable of influencing the results and favouring any of the techniques and is the fairest option for future comparisons.
Topics: Humans; Prostatectomy; Male; Robotic Surgical Procedures; Urinary Incontinence; Laparoscopy; Prostatic Neoplasms; Postoperative Complications
PubMed: 37713071
DOI: 10.1111/bju.16180 -
Urologic Oncology Oct 2019Evidence-based medicine was widely used in the context of diverse surgical treatments through several systematic reviews (SR). Despite the high level of evidence from...
CONTEXT
Evidence-based medicine was widely used in the context of diverse surgical treatments through several systematic reviews (SR). Despite the high level of evidence from these reviews, the specificity of the analyzed outcomes makes it difficult to establish the state of maturity of the analyzed technique neglecting significant bias.
OBJECTIVE
To describe a novel SR methodology based on a temporal population analysis in a Reverse Systematic Review utilizing the case of well-established laparoscopic radical prostatectomy (LRP).
EVIDENCE ACQUISITION
A systematized search was performed in order to obtain the primary studies feeding SR for the composition of a complete database, covering clinical-surgical and bibliometric variables. Quantitative, qualitative, and temporal correlations of studies variables were performed to determine trends regarding results, geographic distribution and bibliometrics to delineate the development and trends of LRP between 2000 and 2017.
EVIDENCE SYNTHESIS
Among a total of 353 SR found, 40 were included and provided 238 primary studies elected to the database composition. An accumulation of studies was found on the Europe-USA axis predominantly in 4 preeminent scientific journals, which scientifically influenced the profile of publications, mainly until 2011 when interest clearly migrates to robotic-assisted surgery reducing the influence of these centers in the development of LRP in an upfront reversal in the standard of publications with a clear shift between LRP and robotic-assisted surgery studies. Operative time, blood loss, and conversion to open surgery showed trend to reduction and only biochemical recurrence (among PENTAFECTA) positively correlated with the year of publication, all with stabilization throughout the period.
CONCLUSION
The Reverse Systematic Review proved to be feasible and effective in demonstrating the evolution of a surgical technique, outlining its "Natural History," which is not captured in the standard SR. In addition, it allowed to identify the presence of scientific influencers and potential biases in the composition of the best evidence in the literature, as well as to trace the curves of development until its technical-scientific maturity. Further studies to test the reproducibility of this methodology may aid in the comparison of diverse surgical techniques. Patient summary: This temporal study analyzed the variables inherent to the publications and the patients in the primary studies of SRs that approached a specific surgical technique. The results demonstrated the scientific maturity of the technique and the vulnerability to scientific influencers in the history of its development.
Topics: Humans; Laparoscopy; Male; Middle Aged; Prostatectomy; Prostatic Neoplasms; Robotic Surgical Procedures
PubMed: 31280983
DOI: 10.1016/j.urolonc.2019.06.004 -
Prostate Cancer and Prostatic Diseases Sep 2023Current guidelines recommend simple prostatectomy or endoscopic enucleation of the prostate (EEP) as treatment of choice for bladder prostatic obstruction (BPO) caused... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Current guidelines recommend simple prostatectomy or endoscopic enucleation of the prostate (EEP) as treatment of choice for bladder prostatic obstruction (BPO) caused by large prostate glands. We aimed to provide a wide-ranging analysis of the currently available evidence, comparing safety and effectiveness of robot-assisted simple prostatectomy (RASP) versus open simple prostatectomy (OSP), laparoscopic simple prostatectomy (LSP), and laser EEP.
METHODS
A systematic search was performed across MEDLINE, EMBASE, and Web of Science databases for retrospective and prospective studies comparing RASP to OSP or LSP or laser EEP (HoLEP/ThuLEP). Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) recommendations were followed to design the search strategies, selection criteria, and evidence report. A meta-analysis evaluated perioperative safety and effectiveness outcomes. The weighted mean difference and risk ratio were used to compare continuous and dichotomous variables, respectively. Quality was assessed using the Newcastle-Ottawa scale and the Cochrane Collaboration's tool for RCT article assessing risk of bias.
RESULTS
15 studies, including 6659 patients, were selected for meta-analysis: 13 observational studies, 1 non-randomized prospective study, and 1 randomized controlled trial. RASP was associated with statistically significant longer operative time (OT) and lower postoperative complication rate, length of stay (LOS), estimated blood loss (EBL), and transfusion rate (TR) compared to OSP. LSP showed longer LOS and lower postoperative SHIM score, with no difference in OT, EBL, and complications. Compared to laser EEP, RASP presented longer LOS and catheterization time and higher TR. ThuLEP presented shorter OT than RASP. No difference were found in functional outcomes between groups both subjectively (IPSS, QoL) and objectively (Qmax, PVR).
CONCLUSION
RASP has become a size-independent treatment for the management of BPO caused by a large prostate gland. It can duplicate the functional outcomes of OSP while offering a better safety profile. When compared to LSP, the latter still stands as a valid lower-cost option, but it requires solid laparoscopic skill sets and therefore it is unlikely to spread on larger scale. When compared to laser EEP, RASP offers a shorter learning curve, but it still suffers from longer catheterization time and LOS.
Topics: Humans; Male; Prospective Studies; Prostatectomy; Prostatic Hyperplasia; Quality of Life; Retrospective Studies; Robotic Surgical Procedures; Treatment Outcome; Controlled Clinical Trials as Topic
PubMed: 36402815
DOI: 10.1038/s41391-022-00616-4 -
ANZ Journal of Surgery Apr 2021Urinary incontinence (UI) is a common complication following radical prostatectomy (RP). Prolonged UI has a substantial impact on quality of life and psychosocial... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Urinary incontinence (UI) is a common complication following radical prostatectomy (RP). Prolonged UI has a substantial impact on quality of life and psychosocial well-being. As the RP technique is complex, it is reasonable to propose that surgeon experience could affect post-operative continence recovery outcomes. This study aimed to systematically evaluate evidence regarding a surgeon's experience and continence recovery after RP.
METHODS
A comprehensive search of the literature was performed in April 2020 using the Medline, Embase, CINAHL and psychINFO electronic databases according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. All English language studies investigating UI following RP, stratified by surgeon experience, were included. Surgeon experience was defined as average annual case load or volume.
RESULTS
Thirteen studies published between 2003 and 2020 met the inclusion criteria and were included in our systematic review. Three prospective and 10 retrospective cohort studies included a total of 47 316 patients undergoing RP via open, laparoscopic or robotic-assisted procedures. Heterogeneity in the definition of surgeon experience and UI did not allow a meta-analysis. The majority of studies reported that surgeons with higher surgical volumes achieved better continence recovery rates at the early (6-week), 3-month, 6-month and later (≥12-month) time points. Most studies where a high surgical volume was defined as >50 cases/year demonstrated a significant difference in continence outcomes.
CONCLUSION
Better urinary continence recovery results can be expected by patients who undergo RP performed by a surgeon with greater experience. An annual surgical case load of >50 cases/year results in improved continence recovery outcomes following RP.
Topics: Humans; Male; Prospective Studies; Prostatectomy; Prostatic Neoplasms; Quality of Life; Recovery of Function; Retrospective Studies; Surgeons; Treatment Outcome
PubMed: 33319438
DOI: 10.1111/ans.16491 -
BMC Urology Jan 2024To summarize current evidence to report a comparative systematic review and meta-analysis of prostatic artery embolization (PAE) with transurethral resection of the... (Meta-Analysis)
Meta-Analysis
Comparing prostatic artery embolization to surgical and minimally invasive procedures for the treatment of benign prostatic hyperplasia: a systematic review and meta-analysis.
BACKGROUND
To summarize current evidence to report a comparative systematic review and meta-analysis of prostatic artery embolization (PAE) with transurethral resection of the prostate (TURP) and open simple prostatectomy (OSP) for the treatment of benign prostatic hyperplasia (BPH).
METHODS
A systematic literature search was performed to identify studies published from inception until August 2021. The search terms used were (prostate embolization OR prostatic embolization) AND (prostatic hyperplasia OR prostatic obstruction) as well as the abbreviations of PAE and BPH. Risk of bias was assessed using the Cochrane Risk of Bias tool for randomized controlled trials (RCTs) and the Risk of Bias in Non-randomized Studies-of Interventions (ROBINS-I) tool for observational studies. Random-effects meta-analysis was performed using Revman 5.4.
RESULTS
Seven studies were included with 810 patients: five RCTs and one observational study compared PAE with TURP, and one observational study compared PAE with OSP. The included studies had considerable risk of bias concerns. TURP and OSP were associated with more statistically significant improvements in urodynamic measures and BPH symptoms compared to PAE. However, PAE seems to significantly improve erectile dysfunction compared to OSP and improve other outcome measures compared to TURP, although not significantly. PAE appeared to reduce adverse events and report more minor complications compared with TURP and OSP, but it is unclear whether PAE is more effective in the long-term.
CONCLUSION
PAE is an emerging treatment option for patients with symptomatic BPH who cannot undergo surgery or have undergone failed medical therapy. Overall, PAE groups reported fewer adverse events. Future ongoing and longer-term studies are needed to provide better insight into the benefit of PAE compared to other treatment options.
Topics: Male; Humans; Prostate; Prostatic Hyperplasia; Treatment Outcome; Transurethral Resection of Prostate; Embolization, Therapeutic; Arteries; Minimally Invasive Surgical Procedures; Lower Urinary Tract Symptoms; Observational Studies as Topic
PubMed: 38281906
DOI: 10.1186/s12894-023-01397-1 -
Urology Aug 2023To collate available data via systematic review considering etiology, presentation, and treatment of Uro-Symphyseal Fistula (USF) in order to inform a contemporary... (Review)
Review
OBJECTIVE
To collate available data via systematic review considering etiology, presentation, and treatment of Uro-Symphyseal Fistula (USF) in order to inform a contemporary management framework.
MATERIALS AND METHODS
A systematic review was performed according to the Cochrane Handbook and registered in PROSPERO (CRD42021232954). MEDLINE and CENTRAL databases were searched for manuscripts considering USF published between 2000 and 2022. Full text manuscripts were reviewed for clinical data. Univariate statistical analysis was performed where possible.
RESULTS
A total of 31 manuscripts, comprising 248 USF cases, met inclusion criteria. Suprapubic pain and difficulty ambulating were common symptoms. MRI confirmed the diagnosis in 95% of cases. Radiotherapy for prostate cancer was the most common predisposing factor (93%). Among these patients, prior endoscopic bladder outlet surgery was common (83%; bladder neck incision/urethral dilatation n = 59, TURP/GLL PVP n = 34). In those with prior prostatic radiation, conservative management failed in 96% of cases. Cystectomy with urinary diversion (86% n = 184) was favored over bladder-sparing techniques (14% (n = 30) after prior radiation. In radiation naïve patients, conservative management failed in 72% of patients, resulting in either open fistula repair with flap (62%) or radical prostatectomy (28%).
CONCLUSION
Prior radiotherapy is a significant risk factor for USF and almost always requires definitive major surgery (debridement, cystectomy, and urinary diversion). On the basis of the findings within this systematic review, we present management principles that may assist clinicians with these complex cases. Further research into pathogenesis, prevention, and optimal treatment approach is required.
Topics: Male; Humans; Fistula; Cystectomy; Urinary Bladder; Urologic Surgical Procedures; Urinary Diversion; Urinary Fistula
PubMed: 37182647
DOI: 10.1016/j.urology.2023.05.002