Objectives To describe a technique to improve exposure of prostate during extraperitoneal robot-assisted radical prostatectomy (EP-RARP). Material and methods From March 2020 to June 2022, a total of 41 patients with prior intra-abdominal surgery underwent EP-RARP. 23 patients improved exposure by traction of prostate through urinary catheter. The catheter traction technology (CTT) group was compared with the standard prostatectomy (SP) group (18 patients) in terms of estimated blood loss (EBL), operative time, positive surgical margin rate, the recovery rate of urinary continence, Gleason score and postoperative hospital stays. Differences were considered significant when P < 0.05. Results The operative time was lower in the CTT group (109.63 min vs. 143.20 min; P < 0.001). EBL in the CTT group was 178.26 ± 30.70 mL, and in the standard prostatectomy group, it was 347.78 ± 53.53 mL (P < 0.001). No significant differences with regard to postoperative hospital stay, recovery rate of urinary continence, catheterization time and positive surgical margin were observed between both groups. No intraoperative complications occurred in all the patients. After 6 months of follow-up, the Post-op Detectable prostate specific antigen was similar between the two groups. Conclusion CTT is a feasible, safe, and valid procedure in EP-RARP. Application of CTT improved the exposure of prostate, reduced operative time and blood loss in comparison with the conventional procedure.

Background To evaluate the efficacy of freehand transperineal prostate biopsies (FTPB) under local anaesthetic (LA) in the outpatient setting without antibiotic. Methods A total of 218 patients suspicious of prostate cancer (PCa) at the multiparametric magnetic resonance imaging (mpMRI) were analyzed retrospectively from January 2020 to September 2021. All patients were biopsy-naive and had no history of PCa. Suspicious areas on mpMRI were defined and graded using Prostate Imaging Reporting and Data System version 2 (PI-RADS v2). FTPB were performed for each suspicious lesion and followed a 12-core systematic transperineal prostate biopsy (STPB) under LA in the outpatient setting without antibiotic. Histopathological outcomes and complications were recorded. Tolerability was evaluated with a visual analog scale (VAS) assessing discomfort caused by probe, LA injections and biopsies. Results PCa was detected in 129 (59.17%) patients and 104 (47.71%) were clinically significant prostate cancer (csPCa). There was exact agreement between FTPB and STPB in 94 (72.88%) patients. FTPB diagnosed 7 cases less PCa than STPB (115 vs 108 cases, P = 0.311) and 19 cases more csPCa than STPB (93 vs 74 cases, P < 0.001). Compared to FTPB alone, the combination of systematic biopsy led to 21 more prostate cancer and 1 more csPCa diagnoses. LA FTPB was well tolerated and no patients developed severe complications (Clavien-Dindo III/IV/V). Conclusions FTPB under LA in the outpatient setting without antibiotic was safe, feasible and efficient.

Background For patients with prior intra-abdominal surgery or multiple arteries, the retroperitoneal robot-assisted partial nephrectomy (rRAPN) is a better choice. The renal ventral tumor poses an additional challenge due to poor tumor exposure. This study is determined to assess the feasibility of an internal traction technique (ITT) in rRAPN for the management of renal ventral tumors. Methods From November 2019 to March 2021, a total of 28 patients with renal ventral tumor underwent rRAPN. All patients had prior abdominal surgery or multiple arteries. The ITT group (20 patients), which improved the tumor exposure by traction of the kidney with suture, was compared with the traditional technique group (8 patients) in terms of warm ischemia time, estimated blood loss and postoperative hospital stay, retroperitoneal drainage, R.E.N.A.L. score, and serum creatinine. Differences were considered significant when P < 0.05. Results All rRAPN surgeries were successful without conversion to radical nephrectomy or open partial nephrectomy. The warm ischemia time was lower in the ITT group (17.10 min vs. 24.63 min; P < 0.05). Estimated blood loss in the traditional technique group was 324.88 ± 79.42 mL, and in the ITT group, it was 117.45±35.25 mL (P < 0.05). No significant differences with regard to postoperative hospital stay, retroperitoneal drainage, R.E.N.A.L. score, and serum creatinine were observed between both groups. Surgical margins were negative and no intraoperative complications occurred in all the patients. After 10 months of follow-up, no recurrence or metastasis occurred in all cases. Conclusion ITT is a feasible, safe, and valid procedure in rRAPN for renal ventral tumors. Application of ITT improved the exposure and reduces warm ischemic time in comparison with the conventional procedure.