Bladder Neck Contracture Following Radical Retropubic versus Robotic-Assisted Laparoscopic Prostatectomy

Abstract

Introduction: Radical retropubic prostatectomy (RRP) and robotic-assisted laparoscopic prostatectomy (RALP) are co-standard surgical therapies for localized prostatic adenocarcinoma. These surgical modalities offer similar outcomes; however, lower rate of bladder neck contracture (BNC) is amongst the touted benefits of RALP. The differences between approaches are largely elucidated through multiple-surgeon comparisons, which can be biased by differential experience and practice patterns. We aimed to eliminate inter-surgeon bias through this single-surgeon comparison of BNC rates following RRP and RALP. Materials and Methods: We retrospectively reviewed all RRPs and RALPs performed by one surgeon over 4 years. We compared clinical characteristics, intraoperative and postoperative outcomes. Results: RRP patients had more advanced cancer and a higher biochemical recurrence rate. No significant differences were noted between groups in rates of anastomotic leakage, BNC, or 12-month postoperative pad-free continence. Conclusion: RRP offers similar outcomes to RALP with regard to postoperative urinary extravasation, urinary continence, and BNC.

Comparison of robotic and open radical prostatectomy: Initial experience of a single surgeon

“…In a study analyzing the experience of a single surgeon in two techniques, no difference was found in terms of anastomosis leakage, 12-month continence rate, and bladder neck contracture. 25 In our study, although the rate of urine leakage and continence rate was in favor of RARP, the rate of contracture was similar in the two groups. The previous study reflected the experience of a single surgeon over four years, and therefore, including cases that exceeded the learning curve may have resulted in similar results in both groups.…”

Robotic-assisted perineal versus transperitoneal radical prostatectomy: A matched-pair analysis

“…Another problem affecting hospitalization stay are postoperative complications, one of which is urinary leakage. Spector et al [18] have reported postoperative urinary leakage at a rate of 4.7% in their robotic radical prostatectomy series. In our study, the urinary leakage rate in the r-PRP group was lower (2.5%) than the rates stated in the literature.…”

Deep lateral transurethral incision for vesicourethral anastomotic stenosis after radical prostatectomy

“…1 In a recent prospective study comparing 2764 RARP and 942 RRP cases, the incidence of VUAS was lower in RARP than in RRP (1.9% vs 3.6%). 2 Even though the incidence of VUAS has been reduced by RARP, VUAS still develops in a certain percentage of cases. Generally, treatment options can be divided into endoscopic therapy, open reconstruction or urinary diversion; however, VUAS should commence with endoscopic therapy.…”

“…1 The incidence of VUAS was reported to be 0.5-33% when open surgery (RRP) was the standard treatment, but has decreased significantly with the advent of robotic surgery, which allows a better field of vision and delicate, reliable suturing. 2 Despite its recently decreased incidence, VUAS remains problematic for both patients and urologists. Several risk factors for VUAS, including older age, cigarette smoking history, comorbidities (e.g.…”