Instituto do Câncer do Estado de São Paulo, Urology, Sao Paulo, Brazil.
To determine whether the presence of median lobe (ML) affects perioperative outcomes, positive surgical margin (PSM) rates and urinary continence outcomes after Robot-Assisted Radical Prostatectomy (RARP).
We analyzed prospectively 1693 consecutive patients who underwent RARP by a single surgeon. Patients were categorized in two groups based on the presence or absence of a ML identified during RARP. Perioperative outcomes, PSM rates and recovery of urinary continence were compared between the groups. Continence was assessed using self-administered validated questionnaires and it was defined as the use of ''no pads''.
A ML was identified in 323 (19%) patients. Both groups had equivalent EBL, length of hospital stay, pathological stage, complication rates, anastomotic leakage rates, overall PSM rates and PSM rate at the bladder neck. The median overall operative time was slightly greater in patients with ML (80 vs. 75minutes, p< 0.001); however, there was no difference in the operative when stratifying this result by prostate weight. Continence rates were also equivalent between patients with and without ML at 1week (27.8% vs. 27%, p=0.870), 4 weeks (42.3% vs. 48%, p=0.136), 12 weeks (82.5% vs. 86.8%, p=0.107) and 24 weeks (91.5% vs. 94.1%, p=0.183) after catheter removal. Finally, the median time to recovery of continence was similar between the groups (median: 5wks, 95% CI: 4.41-5.59 vs. median: 5 wks, CI 4.66-5.34; log rank test, p = 0.113)
The presence of a ML does not affect perioperative outcomes, PSM rates and early continence outcomes in patients undergoing RARP performed by an experienced surgeon.
Written by:
Coelho RF, Chauhan S, Guglielmetti GB, Orvieto MA, Sivaraman A, Palmer KJ, Rocco B, Coughlin G, Hassan RE, Patel VR. Are you the author?
Reference: J Endourol. 2011 Nov 3. Epub ahead of print.
doi: 10.1089/end.2011.0132
PubMed Abstract
PMID: 22050508
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