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Bove AM, Brassetti A, Ochoa M, Anceschi U, D’Annunzio S, Ferriero M, Tuderti G, Misuraca L, Mastroianni R, Cartolano S, Torregiani G, Lombardo R, De Nunzio C, Simone G. Robotic simple prostatectomy vs HOLEP, a 'multi single-center' experiences comparison. Cent European J Urol 2023; 76:128-134. [PMID: 37483855 PMCID: PMC10357823 DOI: 10.5173/ceju.2023.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 01/23/2023] [Accepted: 03/29/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction The aim of this study was to compare peri-operative and mid-term outcomes of patients who underwent robot-assisted simple prostatectomy (RASP) vs holmium laser enucleation of the prostate (HOLEP). RASP and HOLEP are the treatments of choice for men with symptomatic benign prostatic obstruction (BPO) and a prostate ≥80 g, achieving comparable short and mid-term efficacy. No randomized controlled studies have proved the superiority of one technique over the other. Material and methods The prospectively maintained databases of the participating institutions were queried for patients with a prostate volume (PV) ≥80 g, who underwent surgery for BPO between 2011 and 2021. The study population was divided into two subgroups based on surgical approach. Demographics, baseline characteristics, and 12 months outcomes were compared between groups: χ2 and Student t-tests were used for categorical and continuous variables, respectively. The Trifecta composite outcome (post-operative Q-max >15 ml/sec, International Prostate Symptom Score (IPSS) <8 and absence of complications) was used to define surgical quality and the two groups were compared accordingly. Logistic regression analyses investigated predictors of Trifecta achievement. Results We included 97 patients with comparable pre-operative features (all p >0.30): 43 underwent RASP, 54 HOLEP. Median PV was 102 g (IQR 89-120) and Q-max was 7.2 ml/s (IQR 5.4-9.0). The Trifecta rate was 43% overall, higher in the RASP subgroup (56% vs 33%; p = 0.02). The endoscopic approach was its only independent predictor (OR 0.5; 95% CI 0.28-0.88; p = 0.016). Conclusions At univariable regression analysis, surgical approach was the only independent predictor of Trifecta achievement, which was significantly higher in the RASP group compared to HOLEP.
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Affiliation(s)
- Alfredo Maria Bove
- Department of Urology, IRCCS ‘Regina Elena’ National Cancer Institute, Rome, Italy
| | - Aldo Brassetti
- Department of Urology, IRCCS ‘Regina Elena’ National Cancer Institute, Rome, Italy
| | - Mario Ochoa
- Department of Urology, IRCCS ‘Regina Elena’ National Cancer Institute, Rome, Italy
| | - Umberto Anceschi
- Department of Urology, IRCCS ‘Regina Elena’ National Cancer Institute, Rome, Italy
| | - Simone D’Annunzio
- Department of Urology, IRCCS ‘Regina Elena’ National Cancer Institute, Rome, Italy
| | - Marilia Ferriero
- Department of Urology, IRCCS ‘Regina Elena’ National Cancer Institute, Rome, Italy
| | - Gabriele Tuderti
- Department of Urology, IRCCS ‘Regina Elena’ National Cancer Institute, Rome, Italy
| | - Leonardo Misuraca
- Department of Urology, IRCCS ‘Regina Elena’ National Cancer Institute, Rome, Italy
| | - Riccardo Mastroianni
- Department of Urology, IRCCS ‘Regina Elena’ National Cancer Institute, Rome, Italy
| | - Silvia Cartolano
- Department of Urology, IRCCS ‘Regina Elena’ National Cancer Institute, Rome, Italy
| | - Giulia Torregiani
- Department of Urology, IRCCS ‘Regina Elena’ National Cancer Institute, Rome, Italy
| | | | - Cosimo De Nunzio
- Department of Urology, Sant Andrea University Hospital, Rome, Italy
| | - Giuseppe Simone
- Department of Urology, IRCCS ‘Regina Elena’ National Cancer Institute, Rome, Italy
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Brassetti A, Anceschi U, Bove A, Cartolano S, Costantini M, Ferriero M, Mastroianni R, Misuraca L, Tuderti G, Simone G. Partial vs. radical nephrectomy to treat pT3a renal cancers: Propensity score matched analysis of a single center series. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00512-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Anceschi U, Amparore D, Prata F, Checcucci E, Bove A, De Cillis S, Iannuzzi A, Quarà A, Ragusa A, Ortenzi M, Misuraca L, Zampa A, Cartolano S, Spadaro G, Tuderti G, Brassetti A, Ferriero M, Mastroianni R, D’Annunzio S, Guaglianone S, Fiori C, Porpiglia F, Simone G. Predictors of BPH6 achievement for urethral-sparing robot-assisted simple prostatectomy: Results of a multicentric series. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00065-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Bove AM, Brassetti A, Ochoa M, Anceschi U, Ferriero M, Tuderti G, Misuraca L, Mastroianni R, Cartolano S, D’Annunzio S, Torreggiani G, Simone G. Robotic-assisted simple prostatectomy: long-term, trifecta- and pentafecta-based analysis of functional outcomes. Ther Adv Urol 2023. [DOI: 10.1177/17562872221147104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background: Robotic-assisted simple prostatectomy (RASP) proved to be a sound and effective procedure for bladder outlet obstructive symptoms relief. Routinely, the transvesical (Freyer) or transcapsular (Millin) techniques are performed. A novel approach of near-infrared fluorescence imaging (NIFI)-guided urethra-sparing robot-assisted prostatectomy (Madigan) was recently introduced. Objectives: The aim of our study was to evaluate the long-term functional outcomes between the Millin, Freyer, and Madigan RASP. Design: This is a single-center, retrospective evaluation of a prospectively maintained Institutional Review Board–approved database. Methods: Data from patients who have undergone RASP in our center were prospectively collected. Demographics, prostate size, and preoperative flowmetry parameters were assessed. Questionnaires such as International Index of Erectile Function (IIEF), and International Consultation on Incontinence Questionnaire (ICIQ), International prostatic symptoms score (IPSS) with its quality of life (QoL) score, Male Sexual Health Questionnaire (MSHQ), Overactive bladder questionnaire (OABQ) were administered to every patient preoperatively and during follow-up. We tested composite outcomes (trifecta) defined as a combination of postoperative Q-max >15 ml/s, IPSS score < 8, and absence of complications. We also tested a pentafecta which keeps in account the persistence of antegrade ejaculation (MSHQ > 0) and the erectile function maintenance (∆IEEF < 6). Results: Median follow-up was 36 months. Millin, Madigan, and Freyer procedures were performed in 37 (51%), 18 (25%), and 17 (24%) cases, respectively. Trifecta was achieved in 43 (60%) patients. Preoperative ICIQ, postoperative IPSS, postoperative OABQ, and QoL were significantly different between groups (all p < 0.02). Pentafecta was achieved by 14 (20%) patients. The pentafecta group showed a statistically significant advantage in terms of postoperative IPSS and MSHQ ( p < 0.01). Conclusion: RASP provides an effective and durable relief of obstructive symptoms at long-term follow-up, regardless of the technique, achieving the trifecta in the majority of the patients. The Madigan technique is significantly related to the pentafecta achievement.
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Affiliation(s)
- Alfredo Maria Bove
- Urology Department, IRCCS ‘Regina Elena’ National Cancer Institute, via Elio Chianesi 53, 00144 Rome, Italy
| | - Aldo Brassetti
- Urology Department, ‘Regina Elena’ National Cancer Institute, Rome, Italy
| | - Mario Ochoa
- Urology Department, ‘Regina Elena’ National Cancer Institute, Rome, Italy
| | - Umberto Anceschi
- Urology Department, ‘Regina Elena’ National Cancer Institute, Rome, Italy
| | - Marilia Ferriero
- Urology Department, ‘Regina Elena’ National Cancer Institute, Rome, Italy
| | - Gabriele Tuderti
- Urology Department, ‘Regina Elena’ National Cancer Institute, Rome, Italy
| | - Leonardo Misuraca
- Urology Department, ‘Regina Elena’ National Cancer Institute, Rome, Italy
| | | | - Silvia Cartolano
- Urology Department, ‘Regina Elena’ National Cancer Institute, Rome, Italy
| | - Simone D’Annunzio
- Urology Department, ‘Regina Elena’ National Cancer Institute, Rome, Italy
| | - Giulia Torreggiani
- Urology Department, ‘Regina Elena’ National Cancer Institute, Rome, Italy
| | - Giuseppe Simone
- Urology Department, ‘Regina Elena’ National Cancer Institute, Rome, Italy
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