Prostate Volume Influence on Postoperative Outcomes for Patients Undergoing RARP: A Monocentric Serial Analysis of 500 Cases

Abstract

Elevated prostate volume is considered to negatively influence postoperative outcomes after robot-assisted radical prostatectomy (RARP). We aim to investigate the influence of prostate volume on readmissions and complications after RARP. Methods: A total of 500 consecutive patients who underwent RARP between April 2019 and August 2022 were included. Patients were dichotomized into two groups using a prostate volume cut-off of 50 mL (small and normal prostate (SNP) n = 314, 62.8%; large prostate n = 186, 37.2%). Demographic, baseline, and perioperative data were analyzed. The postoperative complications and readmission rates within 90 days after RARP were compared between groups. A univariate linear analysis was performed to investigate the association between prostate volume and other relevant outcomes. Results: Patients with larger prostates had a higher IPSS score, and therefore, more relevant LUTS at the baseline. They had higher ASA scores (p = 0.015). They also had more catheter days (mean 6.6 days for SNP vs. 7.5 days for LP) (p = 0.041). All oncological outcomes were similar between the groups. Although statistical analysis showed no significant difference between the groups (p = 0.062), a trend for minor complications in patients with larger prostates, n = 37/186 (19.8%) for the LP group vs. n = 37/314 (11.7%) in the SNP group, was observed. Namely, acute urinary retention and secondary anastomosis insufficiency. Major complications with an SNP (4.4%) and LP (3.7%) (p = 0.708) and readmissions with an SNP (6.25%) and LP (4.2%) (p = 0.814) were infrequent and distributed equally between the groups. In univariate analysis, prostate volume could solely predict a longer console time (p = 0.005). Conclusions: A higher prostate volume appears to have minimal influence on the perioperative course after RARP. It can prolong catheter days and increase the incidence of minor complications such as acute urinary retention. However, it might predict minor changes in operating time. Yet, prostate volume has less influence on major complications, readmissions, or oncological results.

BMI Impact on Readmissions for Patients Undergoing Robot-Assisted Radical Prostatectomy: A Monocentric, Single-Surgeon Serial Analysis of 500 Cases

“…This was also confirmed for prostate weight in final pathological reports (62 g for OBMI vs. 52 g for NOBMI). As we showed in a previous study [ 21 ], prostate volume can prolong catheter days and increase the incidence of minor complications, such as acute urinary retention. However, prostate volume has less influence on major complications, readmissions and oncological results.…”

“…This can be anticipated through various nomograms, such as Briganti’s [ 19 ] or Partin’s [ 20 ]. Performance of a pelvic lymph adenectomy is associated with longer procedures; elevated intraoperative complications, such as vessel injuries; and postoperative complications, such as symptomatic lymphoceles [ 21 , 22 , 23 ]. Nonetheless, we completed pelvic lymph adenectomies in all our patients regardless of their clinical stage or pathological grade to avoid the risk of under-staging or under-grading because of the high rate of tumor misclassification by referring urologists.…”

Robot-assisted radical prostatectomy in a patient with prostate cancer complicated by benign prostate hypertrophy with middle lobe hypertrophy

“…In some cases, when an incision is made in the prostatic area, the bladder neck may be opened too wide, and a large middle lobe may hang down and obstruct the view when the seminal vesicle and ductus deferens are excised, or the Denonvilliers fascia is removed, thereby increasing the risk of rectal injury. Our technique of lifting the prostate using sutures may reduce the extent of suturing and the risk of rectal injury and contribute to the observed decrease in postoperative complications due to BPH [ 6 ]. We hope that these measures will help ensure a safe and reliable surgery when RARP becomes more widespread.…”