Impact of Prostate Size in Robot-Assisted Radical Prostatectomy

Boczko, Judd; Ertürk, Erdal; Golijanin, Dragan; Madeb, Ralph; Patel, Hitendra; Joseph, Jean

doi:10.1089/end.2006.0163

Cited by 79 publications

(73 citation statements)

References 12 publications

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“…27 It has been suggested that wider dissection of the bladder neck for large prostates can contribute to this association. 28 While smaller prostate volume was associated with continence at 1 month on univariate analysis, this characteristic was not an independent predictor of continence on multivariate analysis.…”

Section: Discussionmentioning

confidence: 81%

Predictors of early continence following robot-assisted radical prostatectomy

Lavigueur-Blouin

Noriega

Valdivieso

et al. 2015

CUAJ

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Introduction: Functional outcomes after robot-assisted radical prostatectomy (RARP) greatly influence patient quality of life. Data regarding predictors of early continence, especially 1 month following RARP, are limited. Previous reports mainly address immediate or 3-month postoperative continence rates. We examine preoperative predictors of pad-free continence recovery at the first follow-up visit 1 month after RARP. Methods: Between January 2007 and January 2013, preoperative and follow-up data were prospectively collected for 327 RARP patients operated on by 2 fellowship-trained surgeons (AEH and KCZ). Patient and operative characteristics included age, body mass index (BMI), staging, preoperative prostate-specific antigen (PSA), prostate weight, International Prostate Symptom Score (IPSS), Sexual Health Inventory for Men (SHIM) score and type of nervesparing performed. Continence was defined by 0-pad usage at 1 month follow-up. Univariate and multivariate logistic regression models were used to assess for predictors of early continence. Results: Overall, 44% of patients were pad-free 1 month post-RARP. In multivariate regression analysis, age (odds ratio [OR] 0.946, confidence interval [CI] 95%: 0.91, 0.98) and IPSS (OR: 0.953, CI 95%: 0.92, 0.99) were independent predictors of urinary continence 1 month following RARP. Other variables (BMI, staging, preoperative PSA, SHIM score, prostate weight and type of nerve-sparing) were not statistically significant predictors of early continence. Limitations of this study include missing data for comorbidities, patient use of pelvic floor exercises and patient maximal activity. Moreover, patient-reported continence using a 0-pad usage definition represents a semiquantitative and subjective measurement. Conclusion: In a broad population of patients who underwent RARP at our institution, 44% of patients were pad-free at 1 month. Age and IPSS were independent predictors of early continence after surgery. Men of advanced age and those with significant lower urinary tract symptoms prior to RARP should be counselled on the increased risk of urinary incontinence in the early stages.

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Section: Discussionmentioning

confidence: 81%

Predictors of early continence following robot-assisted radical prostatectomy

Lavigueur-Blouin

Noriega

Valdivieso

et al. 2015

CUAJ

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“…Boczko et al [23] examined the effects of prostate size on treatment outcomes after extraperitoneal RARP. They evaluated 355 patients who underwent RARP and compared patients with prostate weight <75 g (n = 319) with those having glands ≥75 g (n = 36).…”

Section: Discussionmentioning

confidence: 99%

Robot-Assisted Radical Prostatectomy in Patients with a Pathologic Prostate Specimen Weight ≥100 Grams versus ≤50 Grams: Surgical, Oncologic and Short-Term Functional Outcomes

Labanaris

Zugor²,

Witt³

2012

Urol Int

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Introduction: The objective of this study is to evaluate the surgical, oncological and short-term functional outcomes in patients with a pathologic prostate specimen weight ≥100 g versus patients with a pathologic prostate specimen weight ≤50 g undergoing robot-assisted radical prostatectomy (RARP). Patients and Methods: The records of 4,000 men who underwent RARP from February 2006 to April 2012 were reviewed retrospectively. A total of 185 men had a pathologic prostate specimen weight ≥100 g (group A). A matched pairs analysis was performed using our database to identify men with a pathologic prostate specimen weight ≤50 g but with equivalent clinicopathologic characteristics to serve as the control group (group B). Results: Our results indicated that although the intraoperative results were more than satisfying in patients with large glands, there is a significant increase in blood loss, operative time needed, increased need for bladder neck reconstruction as well as an increase in intraoperative complications. Nevertheless, patients with large glands exhibit less aggressive tumors, less positive surgical margins and a lower incidence of biochemical recurrence. Regarding functional outcomes, patients with larger glands had no difference regarding continence rates when compared to patients with smaller glands but exhibited significantly lower potency rates. Conclusions: Although RARP in patients with a pathologic prostate specimen weight ≥100 g is technically challenging, in experienced hands it can be considered a safe procedure with excellent surgical, oncological and functional outcomes. Nevertheless, this conclusion is limited, in that it is from a single institution with a large case volume and may not be reflective of outcomes at centers with smaller volumes and less experience.

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“…are expected to overcome the technical challenges and inferior surgical outcomes associated with larger prostates. However, the impact of prostate size on surgical and oncological outcomes in RARP has been controversial [1,[4][5][6][7][8][9]. Most research addressing this issue was based on the pathological prostate weight (g) [4][5][6][7][8].…”

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confidence: 99%

Impact of a preoperatively estimated prostate volume using transrectal ultrasonography on surgical and oncological outcomes in a single surgeon’s experience with robot-assisted radical prostatectomy

et al. 2015

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A large prostate size was significantly associated with increased blood loss and a higher rate of perioperative complications. A small prostate size was associated with a higher PSM rate, PSA density, Gleason score, EPE rate, and biochemical recurrence rate. These results suggest that RARP was technically challenging in patients with large prostates, whereas small prostates were associated with unfavorable oncological outcomes.

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Impact of Prostate Size in Robot-Assisted Radical Prostatectomy

Cited by 79 publications

References 12 publications

Predictors of early continence following robot-assisted radical prostatectomy

Predictors of early continence following robot-assisted radical prostatectomy

Robot-Assisted Radical Prostatectomy in Patients with a Pathologic Prostate Specimen Weight ≥100 Grams versus ≤50 Grams: Surgical, Oncologic and Short-Term Functional Outcomes

Impact of a preoperatively estimated prostate volume using transrectal ultrasonography on surgical and oncological outcomes in a single surgeon’s experience with robot-assisted radical prostatectomy

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