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Perioperative and short-term outcomes of Retzius-sparing robot-assisted laparoscopic radical prostatectomy stratified by gland size

 Glen D.R Santok  ;  Ali Abdel Raheem  ;  Lawrence H. C. Kim  ;  Kidon Chang  ;  Trenton G. H. Lum  ;  Byung H. Chung  ;  Young D. Choi  ;  Koon H. Rha 
 BJU INTERNATIONAL, Vol.119(1) : 135-141, 2017 
Journal Title
Issue Date
Adult ; Aged ; Humans ; Laparoscopy* ; Male ; Middle Aged ; Organ Size ; Prostate/pathology* ; Prostatectomy/methods* ; Prostatic Neoplasms/pathology* ; Prostatic Neoplasms/surgery* ; Retrospective Studies ; Robotic Surgical Procedures/methods* ; Time Factors ; Treatment Outcome
Retzius-sparing ; laparoscopy ; prostate cancer ; prostate volume ; radical prostatectomy
OBJECTIVE: To investigate the effect of preoperative prostate volume (PV) on the perioperative, continence and early oncological outcomes among patients treated with Retzius-sparing robot-assisted laparoscopic radical prostatectomy (RS-RALP).

PATIENTS AND METHODS: This is a retrospective analysis of 294 patients with organ-confined prostate cancer treated with RS-RALP in a high-volume centre from November 2012 to February 2015. Patients were divided into three groups based on their transrectal ultrasonography estimated PV as follows: group 1, <40 mL (231 patients); group 2, 40-60 mL (47); group 3, >60 mL (16). Perioperative, oncological, and continence outcomes were compared between the three groups.

RESULTS: The median [interquartile range (IQR)] PV for each group was; 26.1 (22-31) mL, 45.9 (41-50) mL, and 70 (68-85) mL. Blood loss was higher in group 3 compared to groups 2 and 1; at a median (IQR) of 475 (312-575) mL, 200 (150-400) mL, and 250 (150-400) mL, respectively (P = 0.001). The intraoperative transfusion rate was higher in group 3 patients (P = 0.004), while the complication rate did not differ (P = 0.05). The console time was slightly higher but was not statistically significant in group 3 compared to groups 2 and 1; at a mean (sd) of 100 (35) min, 92 (34.4) min, and 93 (24.8) min, respectively (P = 0.70). Biochemical recurrence and the continence rate did not differ between the three groups (P = 0.89 and P = 0.25, respectively).

CONCLUSION: RS-RALP is oncologically and functionally equivalent for all prostate sizes but technically demanding for larger prostates. We therefore recommend that surgeons initiate their RS-RALP technique with smaller prostates.
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1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
Rha, Koon Ho(나군호) ORCID logo https://orcid.org/0000-0001-8588-7584
Raheem, Ali Abdel(알리압델)
Chang, Kidon(장기돈)
Chung, Byung Ha(정병하) ORCID logo https://orcid.org/0000-0001-9817-3660
Choi, Young Deuk(최영득) ORCID logo https://orcid.org/0000-0002-8545-5797
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