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Current Urology Reports May 2017The leading cause of voiding dysfunction in older men is benign prostatic obstruction. In the setting of a grossly enlarged prostate (>80cm), an open simple... (Comparative Study)
Comparative Study Review
PURPOSE OF REVIEW
The leading cause of voiding dysfunction in older men is benign prostatic obstruction. In the setting of a grossly enlarged prostate (>80cm), an open simple prostatectomy has been the gold standard for surgical treatment. Here, we will discuss the minimally invasive robot-assisted approach and compare it to the classic open approach and holmium laser enucleation of the prostate.
RECENT FINDINGS
Literature on robot-assisted simple prostatectomy, in concurrence with our institutional experience, has shown an overall lower morbidity, shorter hospital stay, and decreased indwelling catheter time, with equivalent functional outcomes compared to open simple prostatectomy. Similar operative times and hospital stays were found compared to holmium laser enucleation of the prostate, although a steep learning curve and cost of new equipment hinder the wide spread use of this transurethral approach. On review of current literature in addition to our institutional experience, we favor robot-assisted simple prostatectomy over open simple, based on associated increased morbidity/catheter time/hospital stay, and holium laser enucleation of the prostate, based on steep learning curve and cost of new equipment.
Topics: Humans; Laser Therapy; Lasers, Solid-State; Male; Prostatectomy; Prostatic Hyperplasia; Robotic Surgical Procedures
PubMed: 28303512
DOI: 10.1007/s11934-017-0681-z -
Journal D'urologie 1995
Topics: Humans; Male; Prostatectomy; Prostatic Hyperplasia
PubMed: 7545719
DOI: No ID Found -
Nigerian Journal of Clinical Practice Apr 2022Open suprapubic prostatectomy is attended by significant perioperative haemorrhage and need for blood transfusion.
The modified suprapubic prostatectomy technique is associated with improved hemostasis and decline in blood transfusion rate after open suprapubic prostatectomy compared to the freyers technique.
BACKGROUND
Open suprapubic prostatectomy is attended by significant perioperative haemorrhage and need for blood transfusion.
AIM
To share our experience on how the adoption of a modified suprapubic prostatectomy technique has led to improved hemostasis and decline in the blood transfusion rate after open suprapubic prostatectomy in our center.
PATIENTS AND METHODS
This was a retrospective study comparing two open prostatectomy techniques. The patients in group 1 had Freyer's suprapubic prostatectomy while the patients in group 2 had a modified suprapubic prostatectomy technique. The groups were compared for the effectiveness of hemostasis using change in packed cell volume, clot retention, blood transfusion, and requirement of continuous bladder irrigation.
RESULTS
Both groups were similar concerning age, body mass index (BMI), total prostate-specific antigen (PSA), prostate volume, presence of comorbidities, duration of surgery, and duration of follow-up. The clot retention rate was 34% in group 1 versus 16.4% in group 2, P = 0.030. The clot retention requiring bladder syringe evacuation occurred in 32.1% of the patients in group 1 versus 14.8% in group 2, P = 0.048. The mean change in the packed cell volume (PCV) in group 1 was 8.0 ± 5.3 versus 6.9 ± 3.5 in group 2, P = 0.175. The blood transfusion rate in group 1 was 40.0% versus 13.3% in group 2, P = 0.040. The complication rate in group 1 was 67.2% versus 41.9% in group 2, P = 0.004. A general decline in blood transfusion was noted from January 2011 to December 2019.
CONCLUSION
The modified suprapubic prostatectomy technique was associated with better hemostasis compared to the standard Freyer's prostatectomy technique. It should be a worthwhile addition to the numerous modifications of the original Freyer's suprapubic prostatectomy technique.
Topics: Blood Transfusion; Female; Hemostasis; Humans; Male; Prostatectomy; Retrospective Studies; Urinary Retention
PubMed: 35439901
DOI: 10.4103/njcp.njcp_1391_21 -
Future Oncology (London, England) 2015Since its introduction in the year 2000, robot-assisted radical prostatectomy (RARP) rapidly diffused, and nowadays roughly 70% of all the radical prostatectomies in the... (Review)
Review
Since its introduction in the year 2000, robot-assisted radical prostatectomy (RARP) rapidly diffused, and nowadays roughly 70% of all the radical prostatectomies in the USA are performed using this approach. Interestingly, the broad dissemination of RARP occurred in the absence of comprehensive data coming from prospective randomized trials supporting the superiority of RARP versus the conventional open RP (ORP). Only observations originating from retrospective institutional or large population-based cohorts exist with respect to the comparative effectiveness of the two surgical techniques. What we have learned is that, given an adequate learning curve, RARP leads to better perioperative and long-term functional outcomes compared with ORP, without any compromise to cancer control outcomes. That being said, the substantially higher costs associated with the use of robotics cannot be ignored.
Topics: Humans; Male; Prostatectomy; Prostatic Neoplasms; Robotic Surgical Procedures
PubMed: 26358012
DOI: 10.2217/fon.15.169 -
Quality of Life After Open Radical Prostatectomy Compared with Robot-assisted Radical Prostatectomy.European Urology Focus May 2019Surgery for prostate cancer has a large impact on quality of life (QoL). (Clinical Trial)
Clinical Trial Comparative Study
BACKGROUND
Surgery for prostate cancer has a large impact on quality of life (QoL).
OBJECTIVE
To evaluate predictors for the level of self-assessed QoL at 3 mo, 12 mo, and 24 mo after robot-assisted laparoscopic (RALP) and open radical prostatectomy (ORP).
DESIGN, SETTING, AND PARTICIPANTS
The LAParoscopic Prostatectomy Robot Open study, a prospective, controlled, nonrandomised trial of more than 4000 men who underwent radical prostatectomy at 14 centres. Here we report on QoL issues after RALP and ORP.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
The primary outcome was self-assessed QoL preoperatively and at 3 mo, 12 mo, and 24 mo postoperatively. A direct validated question of self-assessed QoL on a seven-digit visual scale was used. Differences in QoL were analysed using logistic regression, with adjustment for confounders.
RESULTS AND LIMITATIONS
QoL did not differ between RALP and ORP postoperatively. Men undergoing ORP had a preoperatively significantly lower level of self-assessed QoL in a multivariable analysis compared with men undergoing RALP (odds ratio: 1.21, 95% confidence interval: 1.02-1.43), that disappeared when adjusted for preoperative preparedness for incontinence, erectile dysfunction, and certainty of being cured (odds ratio: 1.18, 95% confidence interval: 0.99-1.40). Incontinence and erectile dysfunction increased the risk for poor QoL at 3 mo, 12 mo, and 24 mo postoperatively. Biochemical recurrence did not affect QoL. A limitation of the study is the nonrandomised design.
CONCLUSIONS
QoL at 3 mo, 12 mo, and 24 mo after RALP or ORP did not differ significantly between the two techniques. Poor QoL was associated with postoperative incontinence and erectile dysfunction but not with early cancer relapse, which was related to thoughts of death and waking up at night with worry.
PATIENT SUMMARY
We did not find any difference in quality of life at 3 mo, 12 mo, and 24 mo when open and robot-assisted surgery for prostate cancer were compared. Postoperative incontinence and erectile dysfunction were associated with poor quality of life.
Topics: Adult; Aged; Erectile Dysfunction; Humans; Male; Middle Aged; Neoplasm Grading; Prostatectomy; Prostatic Neoplasms; Quality of Life; Robotic Surgical Procedures; Time Factors; Urinary Incontinence
PubMed: 29366855
DOI: 10.1016/j.euf.2017.12.010 -
The Journal of Urology Jun 2012We describe current trends in robotic and open radical prostatectomy in the United States after examining case logs for American Board of Urology certification.
PURPOSE
We describe current trends in robotic and open radical prostatectomy in the United States after examining case logs for American Board of Urology certification.
MATERIALS AND METHODS
American urologists submit case logs for initial board certification and recertification. We analyzed logs from 2004 to 2010 for trends and used logistic regression to assess the impact of urologist age on robotic radical prostatectomy use.
RESULTS
A total of 4,709 urologists submitted case logs for certification between 2004 and 2010. Of these logs 3,374 included 1 or more radical prostatectomy cases. Of the urologists 2,413 (72%) reported performing open radical prostatectomy only while 961 (28%) reported 1 or more robotic radical prostatectomies and 308 (9%) reported robotic radical prostatectomy only. During this 7-year period we observed a large increase in the number of urologists who performed robotic radical prostatectomy and a smaller corresponding decrease in those who performed open radical prostatectomy. Only 8% of patients were treated with robotic radical prostatectomy by urologists who were certified in 2004 while 67% underwent that procedure in 2010. Median age of urologists who exclusively performed open radical prostatectomy was 43 years (IQR 38-51) vs 41 (IQR 35-46) for those who performed only robotic radical prostatectomy.
CONCLUSIONS
While the rate was not as high as the greater than 85% industry estimate, 67% of radical prostatectomies were done robotically among urologists who underwent board certification or recertification in 2010. Total radical prostatectomy volume almost doubled during the study period. These data provide nonindustry based estimates of current radical prostatectomy practice patterns and further our understanding of the evolving surgical treatment of prostate cancer.
Topics: Age Factors; Certification; Humans; Laparoscopy; Logistic Models; Male; Professional Practice; Prostatectomy; Prostatic Neoplasms; Robotics; United States; Urology
PubMed: 22498227
DOI: 10.1016/j.juro.2012.01.061 -
The Journal of Urology Feb 2007We compared the 12-month postoperative urinary incontinence rates of open radical retropubic and laparoscopic radical prostatectomy. (Comparative Study)
Comparative Study
PURPOSE
We compared the 12-month postoperative urinary incontinence rates of open radical retropubic and laparoscopic radical prostatectomy.
MATERIALS AND METHODS
This prospective study included all men with clinically localized prostate cancer scheduled for radical prostatectomy (open retropubic or laparoscopic) at the University of Alberta between October 1999 and July 2002. Preoperative evaluation included a 24-hour pad test, fluid volume voiding diary and International Prostate Symptom Score questionnaire. Postoperative evaluation included a 24-hour pad test at 3 and 12 months, as well as a voiding diary and International Prostate Symptom Score questionnaire at 3, 6, 9 and 12 months.
RESULTS
A total of 239 patients met the eligibility criteria and consented to participate (172 open radical retropubic prostatectomy, 67 laparoscopic radical prostatectomy). Of the patients 87% (148) treated with open radical retropubic prostatectomy and 88% (57) of those treated with laparoscopic radical prostatectomy completed 12-month followup (p = 0.50). According to 24-hour pad testing 13% of those treated with open radical retropubic prostatectomy and 17% of those treated with laparoscopic radical prostatectomy remained incontinent at 1 year (p = 0.26). There was no difference in 24-hour pad weight, urinary symptom score and urinary quality of life at 1 year between the open and laparoscopic groups overall, or when stratified according to 12-month continence status. The majority of subjects in both groups described mild symptoms and a general satisfaction with urinary quality of life.
CONCLUSIONS
Based on objective and subjective measures, there were no differences in urinary functional outcomes 1 year after open radical retropubic prostatectomy or laparoscopic radical prostatectomy. Urinary incontinence was found to affect a similar proportion of patients who underwent open (13%) and laparoscopic (17%) radical prostatectomy 12 months postoperatively.
Topics: Humans; Laparoscopy; Male; Middle Aged; Prospective Studies; Prostatectomy; Prostatic Neoplasms; Urinary Incontinence
PubMed: 17222646
DOI: 10.1016/j.juro.2006.09.022 -
Journal of Clinical Oncology : Official... May 2008
Topics: Humans; Laparoscopy; Length of Stay; Male; Prostatectomy; Prostatic Neoplasms; Robotics
PubMed: 18467714
DOI: 10.1200/JCO.2008.16.0796 -
BJU International Nov 2013
Topics: Humans; Male; Prostatectomy; Quality of Life; Robotics; Urinary Incontinence
PubMed: 24118951
DOI: 10.1111/bju.12434 -
The Journal of Urology Dec 2014Despite the increased use of minimally invasive radical prostatectomy, open conversion may occur due to surgical complications, surgeon inexperience or failure to...
PURPOSE
Despite the increased use of minimally invasive radical prostatectomy, open conversion may occur due to surgical complications, surgeon inexperience or failure to progress. We used nationally representative data to quantify the impact of open conversion compared to nonconverted minimally invasive radical prostatectomy and open radical prostatectomy, and identify predictors of open conversion.
MATERIALS AND METHODS
Years 2004 to 2010 of the Nationwide Inpatient Sample were queried for patients who underwent radical prostatectomy to analyze the association of open conversion during minimally invasive radical prostatectomy with Clavien complications. Multivariate regression models yielded significant predictors of open conversion.
RESULTS
From 2004 to 2010, 134,398 (95% CI 111,509-157,287) minimally invasive radical prostatectomies were performed with a 1.8% (95% CI 1.4-2.1) open conversion rate, translating to 2,360 (95% CI 2,001-2,720) conversions. Open conversion cases had a longer length of stay (4.17 vs 1.71 days, p <0.001) and higher hospital charges ($51,049 vs $37,418, p <0.001) than nonconverted cases. Of open conversion cases 45.2% experienced a complication vs 7.2% and 12.9% of minimally invasive radical prostatectomy and open radical prostatectomy cases, respectively (p <0.001). After adjusting for age and comorbidities, open conversion was associated with significantly increased odds of a Clavien grade 1, 2, 3 and 4 complication compared to nonconverted minimally invasive radical prostatectomy and open radical prostatectomy (OR range 2.913 to 15.670, p <0.001). Significant multivariate predictors of open conversion were obesity (OR 1.916), adhesions (OR 3.060), anemia (OR 5.692) and surgeon volume for minimally invasive radical prostatectomy less than 25 cases per year (OR 7.376) (all p <0.01).
CONCLUSIONS
Open conversion during minimally invasive radical prostatectomy is associated with a higher than expected increase in complications compared to open radical prostatectomy and minimally invasive radical prostatectomy after adjusting for age and comorbidities. External validation of predictors of open conversion may prove useful in minimizing open conversion during minimally invasive radical prostatectomy.
Topics: Conversion to Open Surgery; Cross-Sectional Studies; Humans; Laparoscopy; Male; Postoperative Complications; Prostatectomy; Prostatic Neoplasms; Retrospective Studies; Robotic Surgical Procedures
PubMed: 24936721
DOI: 10.1016/j.juro.2014.06.029