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Journal of Robotic Surgery Dec 2023The study aims to synthesize all available prospective comparative studies and reports the latest systematic analysis and updated evidence comparing robot-assisted... (Meta-Analysis)
Meta-Analysis Review
The study aims to synthesize all available prospective comparative studies and reports the latest systematic analysis and updated evidence comparing robot-assisted radical prostatectomy (RARP) with open radical prostatectomy (ORP) for perioperative, functional, and oncological outcomes in patients with clinically localized prostate cancer (PCa). PubMed, Embase, Web of Science, and the Cochrane Library were retrieved up to March 2023. Only randomized controlled trials (RCTs) and prospective comparative studies were included, and weighted mean differences (WMD) and odds ratios (OR) were used to evaluate the pooled results. Twenty-one articles were included in the present meta-analysis. The results indicated that compared to ORP, RARP had longer operative time (OT) (WMD: 51.41 min; 95%CI: 28.33, 74.48; p < 0.0001), reduced blood loss (WMD: -516.59 mL; 95%CI: -578.31, -454.88; p < 0.00001), decreased transfusion rate (OR: 0.23; 95%CI: 0.18, 0.30; p < 0.00001), shorter hospital stay (WMD: -1.59 days; 95%CI: -2.69, -0.49; p = 0.005), fewer overall complications (OR: 0.61; 95%CI: 0.45, 0.83; p = 0.001), and higher nerve sparing rate (OR: 1.64; 95%CI: 1.26, 2.13; p = 0.0003), as well as was more beneficial to postoperative erectile function recovery and biochemical recurrence (BCR). However, no significant disparities were noted in major complications, postoperative urinary continence recovery, or positive surgical margin (PSM) rates. RARP was superior to ORP in terms of hospital stay, blood loss, transfusion rate, complications, nerve sparing, postoperative erectile function recovery, and BCR. It is a safe and effective surgical approach to the treatment of clinically localized PCa.
Topics: Male; Humans; Erectile Dysfunction; Prospective Studies; Robotics; Treatment Outcome; Robotic Surgical Procedures; Prostatectomy; Prostatic Neoplasms
PubMed: 37721644
DOI: 10.1007/s11701-023-01714-8 -
The Canadian Journal of Urology Oct 2015Prostatectomy for benign disease, also known as a 'simple prostatectomy', is neither simple in indication nor approach. In the post-Medical Therapy of Prostatic Symptoms... (Comparative Study)
Comparative Study Review
INTRODUCTION
Prostatectomy for benign disease, also known as a 'simple prostatectomy', is neither simple in indication nor approach. In the post-Medical Therapy of Prostatic Symptoms (MTOPS), NCT00021814 trial era, the medical management of benign prostatic hyperplasia (BPH) and consequent bladder outlet obstruction (BOO) has shifted surgical intervention to those patients who are medical-non responders, present with advanced signs of BOO and obstructive uropathy, and those with prostate gland volumes beyond the size normally approachable with standard transurethral resection of the prostate (TURP). Simple prostatectomy through an open surgical approach is associated with improvements in BOO and lower urinary tract symptoms (LUTS) but at the expense of considerable surgical and perioperative morbidity. Advances in technology have made it possible for patients to be offered standard open surgical approaches as well as transurethral approaches with photon-based energy sources (i.e. laser prostatectomy) and laparoscopic simple prostatectomy. A review of the historical challenges of BPH and the standard-of-care of open prostatectomy will put into perspective the potential advantages and disadvantages of laparoscopic and robotic prostatectomy for the treatment of benign BOO due to BPH.
MATERIALS AND METHODS
A careful review of the literature was performed utilizing PubMed and ClinicalKey searches to identify relevant articles. Search terms 'simple prostatectomy', 'robotic simple prostatectomy' and 'laparoscopic simple prostatectomy'.
RESULTS
Over 14 series of open simple prostatectomies and over 20 minimally invasive series were identified and used as a reference. Additionally, several review articles were identified and incorporated.
CONCLUSIONS
Simple prostatectomy may be performed safely in appropriately selected patients utilizing either open or minimally invasive approaches. Clinical criteria should be used to determine the appropriateness of either retropubic versus transvesical approach.
Topics: Aged; Aged, 80 and over; Follow-Up Studies; Humans; Laparoscopy; Laparotomy; Length of Stay; Male; Minimally Invasive Surgical Procedures; Operative Time; Postoperative Complications; Prostatectomy; Prostatic Hyperplasia; Reoperation; Risk Assessment; Robotic Surgical Procedures; Survival Rate; Treatment Outcome
PubMed: 26497345
DOI: No ID Found -
The Urologic Clinics of North America Feb 2010Radical prostatectomy is the gold standard surgical treatment for clinically localized prostate cancer. Over the years, many different approaches to surgical removal of... (Review)
Review
Radical prostatectomy is the gold standard surgical treatment for clinically localized prostate cancer. Over the years, many different approaches to surgical removal of the prostate have been described. Today, the most common techniques are open radical retropubic prostatectomy and robotic-assisted laparoscopic radical prostatectomy. Although there are many differences between the 2 approaches, the common goal is to optimize oncologic and functional outcomes. This article highlights the background, techniques, and outcomes of open and robotic prostatectomy.
Topics: Humans; Male; Prostatectomy; Prostatic Neoplasms; Treatment Outcome
PubMed: 20152519
DOI: 10.1016/j.ucl.2009.11.008 -
Urologic Oncology 2007For more than two decades, open radical prostatectomy has been considered the gold standard for the surgical management of prostate cancer. More recently, however,... (Review)
Review
For more than two decades, open radical prostatectomy has been considered the gold standard for the surgical management of prostate cancer. More recently, however, laparoscopic and now robotic approaches to radical prostatectomy have become increasingly popular. It is unclear whether these techniques are associated with any material advantage with regard to short-term convalescence. In addition, the high positive surgical margin rates reported with robotic prostatectomy are concerning, particularly early in the learning curve. Additional experience with these methods and long-term follow-up data are necessary to determine whether the cancer control and functional outcomes meet the standards of open radical prostatectomy.
Topics: Humans; Laparoscopy; Male; Postoperative Complications; Prostatectomy; Prostatic Neoplasms; Robotics
PubMed: 18047959
DOI: 10.1016/j.urolonc.2007.05.019 -
La Tunisie Medicale Dec 2020Surgical procedures for benign prostate hyperplasia (BPH) had considerably evolved during last decades. New techniques can nowadays treat prostate big in size, which are... (Review)
Review
Surgical procedures for benign prostate hyperplasia (BPH) had considerably evolved during last decades. New techniques can nowadays treat prostate big in size, which are classically treated by open prostatectomy (OP). Therefore, the place of this procedure that has been used for over 150 years is nowadays questioned. Is it outdated? Is there emerging techniques that are more efficient, safer and cost effective? This state of the art based on literature review will assess the place of OP in BPH surgery from efficacy on functional outcomes, security, competitiveness with modern and minimally invasive techniques and socio-economic perspectives. Currently, OP has excellent functional outcomes, with low rate of retreatment after surgery, low morbidity and affordable cost in our country. It remains competitive with new surgery techniques for BPH, even if the latter offer the advantages of a minimally invasive surgery, especially in hospitalization length. Taking in consideration the social and economic context in Tunisia, it remains the most accessible and affordable surgical technique. Besides, OP is a procedure that has to be handled by every urologist given the theoretical risk of conversion during endoscopic surgery of BPH, and its use under certain circumstances (In case of bladder lithiasis ou diverticle or impossibility of lithotomy position).
Topics: Cost-Benefit Analysis; Humans; Length of Stay; Male; Minimally Invasive Surgical Procedures; Prostatectomy; Prostatic Hyperplasia
PubMed: 33479998
DOI: No ID Found -
BJU International Aug 2023To report open-label phase data from a recent randomized controlled trial (RCT), after previous data from that study showed improved penile length and erectile function... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To report open-label phase data from a recent randomized controlled trial (RCT), after previous data from that study showed improved penile length and erectile function among post-prostatectomy men treated with Restorex penile traction therapy (RxPTT).
MATERIALS AND METHODS
An RCT (NCT05244486) was performed to evaluate RxPTT vs no treatment (Tx) for 5 months, which was followed by a 3-month open-label phase. Men were stratified based on as-treated data: Group 1 = No Tx; Group 2 = No Tx → Tx; Group 3 = Tx → No Tx; Group 4 = Tx. Assessments included stretched penile length and standardized (International Index of Erectile Function [IIEF]) and non-standardized questionnaires.
RESULTS
A total of 82 men were enrolled (mean age 58.6 years) with 9-month data available in 45 of the men. Baseline characteristics were similar among the cohorts. Comparing Group 1 and Group 4 (respectively), notable differences included: IIEF Erectile Function domain (IIEF-EF) score (-8 vs -0.5; P = 0.16), penile length (-0.1 vs +1.7 cm; P < 0.01), intracavernosal injection use (86% vs 14%; P < 0.01), Sexual Encounter Profile (SEP) Question 2 (50% vs 100%; P < 0.01), SEP Question 3 (33% vs 100%; P < 0.01). Men who crossed over to Tx (Group 2) failed to achieve equivalent improvements in length (+0.5 cm) or sexual function (IIEF-EF score -6) compared to men treated early (Groups 3 and 4). Those who crossed over to no treatment after initial treatment (Group 3) experienced preserved length (+1.8 cm), and erectile function (IIEF-EF score +0) despite therapy discontinuation.
CONCLUSIONS
Use of RxPTT beginning 1 month post-prostatectomy results in improved penile length and erectile function, with benefits maintained after discontinuing therapy. If confirmed, these results represent the first postoperative therapy shown in a RCT to improve erectile function post-prostatectomy. External validation is warranted.
Topics: Male; Humans; Middle Aged; Erectile Dysfunction; Penile Erection; Prostatectomy; Penis; Sexual Behavior; Treatment Outcome
PubMed: 37088866
DOI: 10.1111/bju.16033 -
Urologic Oncology 2007Surgical removal of clinically localized prostate cancer remains the most definitive treatment for the disease. The emergence of laparoscopic and robotic radical... (Review)
Review
Surgical removal of clinically localized prostate cancer remains the most definitive treatment for the disease. The emergence of laparoscopic and robotic radical prostatectomy (RP) as alternatives to open RP has generated considerable discussion about the real and relative merits of each approach. Such was the topic of a debate that took place during the 2006 Society of Urologic Oncology meeting. The participants were Dr. William Catalona, Northwestern University, advocating for open RP, Dr. Betrand Guillonneau, Memorial Sloan Kettering Cancer Center advocating for laparoscopic RP, and Dr. Mani Menon, Henry Ford Hospital, advocating for robotic RP. The debate was moderated by Dr. Joel Nelson, University of Pittsburgh. This paper summarizes that debate.
Topics: Humans; Laparoscopy; Length of Stay; Male; Postoperative Complications; Prostatectomy; Prostatic Neoplasms; Robotics
PubMed: 18047958
DOI: 10.1016/j.urolonc.2007.05.018 -
International Braz J Urol : Official... 2016
Topics: Humans; Learning Curve; Male; Organ Size; Postoperative Complications; Prostatectomy
PubMed: 27564270
DOI: 10.1590/S1677-5538.IBJU.2016.04.01 -
West African Journal of Medicine Sep 2023Haemorrhage is a common complication following open simple prostatectomy and patients may sometimes require a blood transfusion. Tranexamic acid has been shown to reduce... (Review)
Review
BACKGROUND
Haemorrhage is a common complication following open simple prostatectomy and patients may sometimes require a blood transfusion. Tranexamic acid has been shown to reduce blood loss following transurethral resection of the prostate and open radical prostatectomy. This study evaluated the effect of perioperative intravenous administration of tranexamic acid on blood loss and blood transfusion rates in patients who had OSP for benign prostatic enlargement.
METHODOLOGY
This was a comparative study of patients with documented prostate glands 60g and above scheduled for OSP. Initial hematocrit was done a day before surgery. The patients were randomized into a tranexamic acid group, which received perioperative intravenous tranexamic acid and the no-TXA group which received placebo (0.9% saline). All patients had open simple retropubic prostatectomy. Final post-operative hematocrit was assessed 72 hours after surgery, and blood loss was calculated using the modified Gross formula (actual blood loss = estimated blood volume x change in hematocrit / mean hematocrit). The transfusion rate was documented.
RESULTS
Fifty-six patients participated in this study and were randomized into a tranexamic acid group and no-tranexamic acid group. The mean age of patients in the tranexamic acid group was 66.07 ±7.08 years and was comparable to the no- tranexamic acid group which was 66.50 ± 8.80 years (P = 0.842). The median total blood loss was lower in the tranexamic acid group (502mls, IQR 613) compared to the no-tranexamic acid group (801mls, IQR 1069). The difference in the median blood loss between the two groups was 299mls (U 275, P 0.055). The rate of blood transfusion was lower in the tranexamic acid group (6 patients, 21%) compared to the no tranexamic acid group (11 patients, 39%), (P = 0.146). There was no difference in complication rates between the two groups.
CONCLUSION
The use of tranexamic acid in patients undergoing open simple prostatectomy showed a trend towards reduced intraoperative blood loss and less need no tranexamic for blood transfusion. This is of clinical significance, especially in elderly patients with low cardiovascular reserve.
Topics: Aged; Male; Humans; Middle Aged; Tranexamic Acid; Prospective Studies; Transurethral Resection of Prostate; Prostatectomy; Hemorrhage; Randomized Controlled Trials as Topic
PubMed: 37767102
DOI: No ID Found -
Urology Journal Jan 2022Benign prostatic hyperplasia (BPH) is one of the most common problems in elderly men. Transurethral resection of the prostate (TURP) can be performed for most patients...
PURPOSE
Benign prostatic hyperplasia (BPH) is one of the most common problems in elderly men. Transurethral resection of the prostate (TURP) can be performed for most patients who need re-do prostate surgery, but open prostatectomy should be considered in patients with prostate size larger than 70 grams. This study assessed the feasibility of open prostatectomy (OP) after previous TURP in patients whose prostate size was larger than 70 grams.
MATERIALS AND METHODS
We subdivided patients into two groups: group 1 included patients who had a history of prostate surgery presented with severe voiding symptoms and a large prostate (>70 gram). Patients who were candidate for open simple prostatectomy without a history of prostate surgery were allocated to group 2.
RESULTS
Between June 2007 and April 2018, 2700 patients underwent TURP or open prostatectomy in our department. 152 of 2700 patients came to us because of severe voiding symptoms after previous prostate surgery, but only 30 patients met the criteria to be enrolled in this study. Perioperative complication (capsular perforation) occurred in 4 (13.3%) patients in group 1 whereas none of the patients in the group 2 had capsular perforation. Hemoglobin drop in group 1 was not significantly different from patients in group 2. The rate of blood transfusion did not differ between the groups (2 [6.6%] patients in group 1 and 41 (5.6%) patients in group 2). After 6-12 months, re-operation rate because of urethral/bladder neck stricture was done in 10 (30%) patients in group 1 and 15 (2%) patients in group 2 (p < 0.05). Four (13.3%) patients in group 1 complained of urinary leakage (more than one pad per day) 6 months after the operation whereas 5 patients in group 2 used more than one pad per day (0.7%) (p > 0.05). Hospital stay was slightly longer in patients in group 1. Six months after the operation, the patients' quality of life was better in group 2 compared with group 1 (p < 0.05).
CONCLUSION
Open simple prostatectomy was a feasible procedure in patients with large prostate after previous TURP, but it was associated with more complications in the long term.
Topics: Aged; Feasibility Studies; Female; Humans; Male; Prostate; Prostatectomy; Prostatic Hyperplasia; Quality of Life; Transurethral Resection of Prostate; Treatment Outcome; Urethral Stricture
PubMed: 35066864
DOI: 10.22037/uj.v18i.6468