Laparoscopic simple prostatectomy: a large single-center prospective cohort study

Andraca, A. Zarraonandia; Lombardo, Riccardo; Valencia, Almudena Carrion; Gonzalez-Dacal, J.A.; Núñez, H. Rodríguez; Mateo, Paula Samper; Sica, Angela; Tema, Giorgia; Nunzio, Cosimo De; Tubaro, Andrea; Moldes, M. Ruibal

doi:10.23736/s2724-6051.19.03567-7

Cited by 13 publications

(4 citation statements)

References 22 publications

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“…С тех пор применение этой методики получило распространение, накоплен значительный опыт её применения. Стало известно, что применение лапароскопической аденомэктомии сопряжено с много-численными преимуществами, в том числе с низкой частотой повторных операций, высокими функциональными показателями, снижением частоты осложнений [15]. Было обнаружено, что по сравнению с открытой хирургией лапароскопическая аденомэктомия связана с меньшей кровопотерей, более коротким периодом послеоперационной катетеризации и более коротким сроком пребывания в стационаре [16] Данные литературы свидетельствуют о том, что в случае применения стандартной лапароскопической аденомэктомии частота развития осложнений I степени по шкале Clavien-Dindo при выполнении лапароскопической аденомэктомии составляет 5%, II степени -0,6 -14,0%, III степенипорядка 8%, IV степени -1,3% [9, 19 -25].…”

Section: Discussionunclassified

Surgical treatment of large-volume benign prostate hyperplasia: a comparative analysis of the outcomes of using standard and modified laparoscopic retropubic simple prostatectomy combined with temporary clamping of the internal iliac arteries and vesicourethral anastomosis

Volkov,

Pushkar,

Kolontarev

et al. 2024

Vestn. Urol.

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Introduction. The optimal approaches to the surgical treatment of large-volume benign prostatic hyperplasia (BPH) have not yet been determined, but laparoscopic retropubic simple prostatectomy (LSP) is one of the preferred methods of surgical treatment for large-volume BPH. There are limitations to standard approaches to LSP, which necessitate the development of improved techniques.Objective. To provide comparative analysis of the efficacy and safety of standard LSP and modified LSP combined with temporary clamping of the internal iliac arteries and vesicourethral anastomosis.Materials & methods. The present multicenter study included 300 patients (mean age 67.0 ± 5.2 years) who were randomly assigned to standard and modified LSP groups. The main efficacy criteria of the intervention during 6 months of observation were: the severity of symptoms of urinary disorders (IPSS score), quality of life, peak urine flow rate and residual urine volume. All complications developed during the postoperative follow-up were recorded.Results. Of the 300 patients, 149 underwent standard LSP, and 151 underwent a modified LSP. Significant differences were detected in the hospital stay (p = 0.032), the rate of decrease in hemoglobin (p = 0.020) and the irrigation time (p = 0.001). In addition, the use of the modified technique was associated with a lower incidence of short-term urinary incontinence (p = 0.031), urinary retention due to urethral catheter occlusion (p = 0.002), and incidence of bladder tamponade (p = 0.001). After 6 months of postoperative follow-up, the groups were comparable in most of outcomes, except for peak urine flow (23.9 ± 2.3 and 20.3 ± 1.9 ml/s in the modified and standard LSP groups, respectively, p = 0.001). After 6 months of postoperative follow-up, the modified LSP group had a lower incidence of bladder tamponade (p = 0.010), urge urinary incontinence (p = 0.002) and bladder neck contracture (p = 0.031).Conclusion. The effectiveness of the modified LSP as a method of surgical treatment of large-volume BPH is not inferior to those in the standard LSP group, and the safety profile suggests the feasibility of wider testing of the technique in practice.

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Section: Discussionunclassified

Surgical treatment of large-volume benign prostate hyperplasia: a comparative analysis of the outcomes of using standard and modified laparoscopic retropubic simple prostatectomy combined with temporary clamping of the internal iliac arteries and vesicourethral anastomosis

Volkov,

Pushkar,

Kolontarev

et al. 2024

Vestn. Urol.

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“…Since then, it has been externally validated by other authors. 8,23 In Autorino’s paper, the achievement of the trifecta was associated with operative time and estimated blood loss. However, these results differ from those reported in the study by Pavan et al , 8 in which only age and BMI were associated with the trifecta.…”

Section: Discussionmentioning

confidence: 99%

Robotic-assisted simple prostatectomy: long-term, trifecta- and pentafecta-based analysis of functional outcomes

Bove

Brassetti²,

Ochoa³

et al. 2023

Therapeutic Advances in Urology

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Background: Robotic-assisted simple prostatectomy (RASP) proved to be a sound and effective procedure for bladder outlet obstructive symptoms relief. Routinely, the transvesical (Freyer) or transcapsular (Millin) techniques are performed. A novel approach of near-infrared fluorescence imaging (NIFI)-guided urethra-sparing robot-assisted prostatectomy (Madigan) was recently introduced. Objectives: The aim of our study was to evaluate the long-term functional outcomes between the Millin, Freyer, and Madigan RASP. Design: This is a single-center, retrospective evaluation of a prospectively maintained Institutional Review Board–approved database. Methods: Data from patients who have undergone RASP in our center were prospectively collected. Demographics, prostate size, and preoperative flowmetry parameters were assessed. Questionnaires such as International Index of Erectile Function (IIEF), and International Consultation on Incontinence Questionnaire (ICIQ), International prostatic symptoms score (IPSS) with its quality of life (QoL) score, Male Sexual Health Questionnaire (MSHQ), Overactive bladder questionnaire (OABQ) were administered to every patient preoperatively and during follow-up. We tested composite outcomes (trifecta) defined as a combination of postoperative Q-max >15 ml/s, IPSS score < 8, and absence of complications. We also tested a pentafecta which keeps in account the persistence of antegrade ejaculation (MSHQ > 0) and the erectile function maintenance (∆IEEF < 6). Results: Median follow-up was 36 months. Millin, Madigan, and Freyer procedures were performed in 37 (51%), 18 (25%), and 17 (24%) cases, respectively. Trifecta was achieved in 43 (60%) patients. Preoperative ICIQ, postoperative IPSS, postoperative OABQ, and QoL were significantly different between groups (all p < 0.02). Pentafecta was achieved by 14 (20%) patients. The pentafecta group showed a statistically significant advantage in terms of postoperative IPSS and MSHQ ( p < 0.01). Conclusion: RASP provides an effective and durable relief of obstructive symptoms at long-term follow-up, regardless of the technique, achieving the trifecta in the majority of the patients. The Madigan technique is significantly related to the pentafecta achievement.

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“…Для зменшення та уникнення зазначених вище ускладнень і наслідків відкритих простатектомій у практику урологів у 2002 р. впроваджено лапароскопічну простатектомію [4][5][6][7], а у 2008 р. -лапароскопічну робот-асистовану простатектомію [8][9][10][11][12][13][14][15]. Ці операції об'єднують одним терміном -«мінімально інвазивні простатектомії».…”

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“…При лапароскопічній екстраперитонеальній простатектомії енуклеацію (видалення) гіперплазованих вузлів ПЗ проводять шляхом поперечного розсічення шийки сечового міхура (міхурово-простатичного з'єднання), поздовжнього розсічення передньої стінки сечового мухура та капсули ПЗ (міхурово-капсулярний розріз), або ж поперечного розсічення капсули ПЗ (на 1 см дистальніше міхурово-простатичного з'єднання) [22][23][24][25]. Останній доступ називають залобковим (транскапсулярним) [3,[16][17].…”

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Laparoscopic Prostatectomy in Surgical Treatment of Benign Prostatic Hyperplasia

Moraru-Burlesku,

Shaprynskyi,

Gorovyi

et al. 2023

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In a contrast to the trauma of open prostatectomy, an alternative treatment for benign prostatic hyperplasia (BPH) is laparoscopic prostatectomy. It was implemented in the practical work of urologists as a minimally invasive alternative procedure to open prostatectomies (transvesical and pubic) in patients with large BPH. The objective: to consider technique and analysis of the results of laparoscopic extraperitoneal pubic (transcapsular) prostatectomy in patients with large BPH (more than 80 ml). Materials and methods. The early (inpatient) and long-term (after discharge from the hospital and up to two years of followup) results of laparoscopic extraperitoneal pubic (transcapsular) prostatectomy in 50 patients with BPH who were operated in Center for Plastic Reconstructive and Minimally Invasive Oncourology of the Cherkasy Regional Oncology Dispensary and the Urology Department of the Vinnytsia Regional Clinical Hospital named after M. I. Pirogov during 2021–2023 are presented. The average age of the patients was 68.2±2.4 years old, the average body mass index was 28.5±1.5, and the average volume of the prostate gland (PG) was 111.5±17.4 ml. Laparoscopic extraperitoneal pubic prostatectomy was performed by creating a pre-abdominal pubic space using a Space Marker balloon trocar. The incision of the PG capsule is transverse, hyperplastic parts of the bladder were removed with step-by-step hemostasis with an attempt to preserve the wall of the prostatic urethra, the anastomosis between the bladder neck and the bladder capsule was placed using a continuous V-Loc suture (2-0). Hyperplastic nodes of the PG were removed by morcellation. The urethral catheter was removed on the 5th day after surgery. The quality of urination before and after surgery was assessed using the International Symptom Questionnaire for PG diseases before and after surgery. Results. The average operation time was 120.3±11.7 min, the average intraoperative blood loss was 118.7±33.6 ml. In 10 (20%) patients the prostatic part of the ureter was saved. One patient had a stone removed from the urinary bladder by cystotomy, another patient had simultaneous pre-abdominal laparoscopic inguinal hernioplasty with a mesh polypropylene implant for an oblique hernia. No intraoperative or postoperative bleeding was observed, no hemotransfusion was performed. The average postoperative bed-day was 6.1±1.1 days. In the postoperative period (up to two years), complications (ureteral and bladder neck strictures, bladder stones, urinary incontinence, infectious complications, etc.) were not registered. Conclusions. The obtained results of laparoscopic extraperitoneal pubic prostatectomy in patients with large BPH confirmed its reliable intra- and postoperative hemostasis, short postoperative bed-day, satisfactory recovery of the act of urination with a minimum number of complications. Further studies should be conducted to establish the benefits of performing laparoscopic extraperitoneal pubic prostatectomy in patients with BPH.

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Laparoscopic simple prostatectomy: a large single-center prospective cohort study

Cited by 13 publications

References 22 publications

Surgical treatment of large-volume benign prostate hyperplasia: a comparative analysis of the outcomes of using standard and modified laparoscopic retropubic simple prostatectomy combined with temporary clamping of the internal iliac arteries and vesicourethral anastomosis

Surgical treatment of large-volume benign prostate hyperplasia: a comparative analysis of the outcomes of using standard and modified laparoscopic retropubic simple prostatectomy combined with temporary clamping of the internal iliac arteries and vesicourethral anastomosis

Robotic-assisted simple prostatectomy: long-term, trifecta- and pentafecta-based analysis of functional outcomes

Laparoscopic Prostatectomy in Surgical Treatment of Benign Prostatic Hyperplasia

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