Robot-Assisted Radical Prostatectomy After Previous Prostate Surgery.

Our objective is to clarify the effect of previous transurethral resection of the prostate (TURP) or open prostatectomy (OP) on surgical, oncological, and functional outcomes after robot-assisted radical prostatectomy (RARP).

Between August 1, 2009, and March 31, 2013, 380 patients underwent RARP. Of these, 25 patients had undergone surgery for primary bladder outlet obstruction (TURP, 20 patients; OP, 5 patents) (group 1). A match-paired analysis was performed to identify 36 patients without a history of prostate surgery with equivalent clinicopathologic characteristics to serve as a control group (group 2). Patients followed up for 12 months were assessed.

Both groups were similar with respect to preoperative characteristics, as mean age, body mass index, median prostate-specific antigen, prostate volume, clinical stage, the biopsy Gleason score, D'Amico risk, the American Society of Anesthesiologists (ASA) classification score, the International Prostate Symptom Score, continence, and potency status. RARP resulted in longer console and anastomotic time, as well as higher blood loss compared with surgery-naive patients. We noted a greater rate of urinary leakage (pelvic drainage, >4 d) in group 1 (12% vs 2,8%). The anastomotic stricture rate was significantly higher in group 1 (16% vs 2. 8%). No difference was found in the pathologic stage, positive surgical margin, and nerve-sparing procedure between the groups. Biochemical recurrence was observed in 12% (group 1) and 11. 1% (group 2) of patients, respectively. No significant difference was found in the continence and potency rates.

RARP after TURP or OP is a challenging but oncologically promising procedure with a longer console and anastomosis time, as well as higher blood loss and higher anastomotic stricture rate.

JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons. 0000 [Epub]

Volkan Tugcu, Arda Atar, Selcuk Sahin, Taner Kargi, Kamil Gokhan Seker, Yusuf IlkerComez, Ali IhsanTasci

Department of Urology, Bakirkoy, Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey. , Department of Urology, Bakirkoy, Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey. , Department of Urology, Bakirkoy, Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey. , Department of Urology, Bakirkoy, Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey. , Department of Urology, Bakirkoy, Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey. , Department of Urology, Bakirkoy, Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey. , Department of Urology, Bakirkoy, Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey.

PubMed