Division of Urology, Department of Surgery,Departments of Radiation Pathology, Taichung Veterans General Hospital Institute of Nursing, College of Nursing, Central Taiwan.University of Science and Technology Institute of Medicine, Chung Sang Medical University, Taichung Graduate Institute of Biomedicine and Biomedical Technology, Department of Applied Chemistry, National Chi-Nan University, Nantou, Taiwan; New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA.
Study Type - Therapy (case series) Level of Evidence 4.
What's known on the subject? and What does the study add? Retro-apical transection of urethra during RARP in an Asian population was found to be feasible. A dedicated team, using robot-assisted surgery, with a skillful assistant are required for the procedure to become standard practice. We would recommend the retro-apical approach for all patients receiving RARP, as it was not found to increase surgical risk or complication. The continence rate at 3 months and 6 months were similar between two groups (70% and 95% in retro-apical group vs 60% and 90% in anterior-apical group).
To assess the feasibility of retro-apical transection of the urethra during robot-assisted radical prostatectomy (RARP) in an Asian population.
Eighty consecutive patients with clinically localized prostate cancer underwent RARP performed by a single surgeon. Patients who underwent retro-apical or anterior-apical urethral transection during RARP were allocated to Group 1 or Group 2, respectively. Preoperative clinical characteristics were recorded, pelvic bone measurements taken and prostatic apex shape was assessed using magnetic resonance imaging. Operating characteristics were compared between the groups and pathological outcomes were assessed.
Of the 80 patients, 75% were in Group 1 and 25% in Group 2. Pelvic bone size and apex shape were similar between the two groups. Group 2 had a significantly higher mean (sd) preoperative body mass index (BMI) than Group 1 (27.43 [4.15] vs 23.50 [2.71] kg/m2 ; P < 0.001) and significantly higher prostate weight than Group 1 (52.00 [31.89] vs 36.55 [11.57] g; P < 0.05). More of those in Group 2 than in Group 1 had undergone previous transurethral resection of the prostate ([TURP] 25% vs 1.67%; P= 0.003) and the mean tumour volume in Group 2 was significantly higher than in Group 1 (15.17 vs 8.10 mL; P= 0.049). The incidence of retro-apical transection of the urethra was 62.5% and 82.5% in the initial 40 cases and subsequent 40 cases, respectively (P= 0.02).
High BMI, larger prostate volume and previous TURP, but not pelvic bone size or apex shape, might hinder retro-apical transection of the urethra.
Ou YC, Hung SW, Wang J, Yang CK, Cheng CL, Tewari AK. Are you the author?
Reference: BJU Int. 2011 Oct 12. Epub ahead of print.