To evaluate the effect of prostate size on surgical outcomes in single-port robot-assisted radical prostatectomy (SP-RARP).
We conducted a multicentre analysis of patients undergoing SP-RARP between 2018 and 2024. Our primary endpoint was to assess the impact of prostate size on SP-RARP surgical outcomes, including operating time, estimated blood loss (EBL), nerve-sparing status, margin status, and intra-/postoperative complications. Logistic regression models assessed the independent impact of prostate size (calculated at final pathology) on these outcomes.
A total of 343 patients were included; the median (interquartile range) prostate size was 46 (37-52) g. Of these, 114 patients had a prostate size of ≤40 g, 175 of 41-69 g, and 54 of ≥70 g. Larger prostates were associated with significantly prolonged operating time (265 vs 301 vs 306 min, P < 0.001), increased EBL (100 vs 100 vs 150 mL, P = 0.012), and lower nerve-sparing rates (79% vs 64% vs 44%, P < 0.001). Non-focal positive margins occurred in 23% of cases, with no significant differences across size groups (P = 0.6), nor for intraoperative (P = 0.2) or for postoperative complications (P > 0.9) rates between prostate size groups. In multivariable logistic regression, prostate size remained an independent predictor of prolonged operating time above median (P = 0.012), increased EBL above median (P = 0.007), and lower nerve-sparing (P = 0.002). No significant association was found with margin status (P = 0.092) or postoperative complications (P > 0.9).
Prostate size impacts intraoperative complexity in SP-RARP but does not increase complication or margin rates. These findings support the feasibility and safety of SP-RARP across a broad range of prostate sizes, consistent with trends reported for multiport RARP.
BJU international. 2026 Mar 31 [Epub ahead of print]
Alessio Finocchiaro, Muhannad Aljoulani, Mustafa Almajedi, Viganò Silvia, Alessandro Bertini, Arianna Biasatti, Fabio Maria Valenzi, Vincenzo Ficarra, Gabriele Sorce, Andrea Salonia, Alberto Briganti, Francesco Montorsi, Giovanni Lughezzani, Nicolò Buffi, Vourganti Srinivas, Riccardo Autorino, Simone Crivellaro, Ryan J Nelson, Craig Rogers, Firas Abdollah
Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA., Department of Urology, University of Illinois at Chicago, Chicago, IL, USA., Department of Urology, Henry Ford Macomb, Clinton Township, MI, USA., Department of Urology, Rush University Medical Center, Chicago, IL, USA., Department of Clinical and Experimental Medicine, Urologic Section, University of Messina, Messina, Italy., Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy., Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Italy., Michigan Institute of Urology, Detroit, MI, USA.