Robotic-Assisted vs. Open Simple Prostatectomy for Large Prostates: A Meta-Analysis

Abstract

Purpose: To compare the efficacy and safety of robotic-assisted simple prostatectomy and open simple prostatectomy for large benign prostatic hyperplasia.Methods: We systematically searched the Cochrane Library, PubMed, Embase, and Science databases for studies published through December 2020. Controlled trials on RASP and OSP for large prostates were included. The meta-analysis was conducted with the Review Manager 5.4 software.Results: A total of seven studies with 3,777 patients were included in the analysis. There were no significant differences in IPSS (WMD, 0.72; 95%CI: −0.31, 1.76; P = 0.17), QoL (WMD, 0.00; 95%CI: −0.39, 0.39; P > 0.99), Qmax (WMD, 1.88; 95% CI: −1.15, 4.91; P = 0.22), or PVR (WMD, −10.48; 95%CI: −25.13, 4.17; P = 0.16) among patients undergoing RASP and OSP. However, compared with patients who underwent OSP, patients who underwent RASP had a shorter LOS (WMD, −2.83; 95%CI: −3.68, −1.98; P < 0.001), less EBL (WMD, −304.68; 95% CI: −432.91, −176.44; P < 0.001), a shorter CT (WMD, −2.61; 95%CI: −3.94, −1.29; P < 0.001), and fewer overall complications (OR, 0.30; 95% CI: 0.16, 0.57; P < 0.001). Nevertheless, RASP was associated with a longer OT (WMD, 59.69, 95% CI: 49.40, 69.98; P < 0.001).Conclusion: The results of the current study demonstrated that RASP provided similar efficacy to those of OSP in the treatment of large prostate, while maintaining better security. Our findings indicate that RASP is a feasible and effective alternative to OSP.

Comparing prostatic artery embolization to surgical and minimally invasive procedures for the treatment of benign prostatic hyperplasia: a systematic review and meta-analysis

“…There are risks associated with the TURP procedure due to its surgical nature such as retrograde ejaculation, and patient outcomes are shown to be variable [ 1 , 4 ]. In addition, open simple prostatectomy (OSP) is an alternative surgical technique to TURP used to treat LUTS secondary to BPH [ 6 ]. OSP is thought to be more advantageous for men with moderate to severe LUTS and a prostate size that exceeds 80 mL [ 7 , 8 ].…”

“…Notably, this technique may also be preferred when treating concomitant bladder stones as these can be extracted simultaneously [ 9 ]. However, OSP has been associated with notable perioperative morbidity including bleeding complications, necessitating the introduction of newer and minimally invasive treatments [ 6 ].…”

Incidence and management of BPH surgery-related urethral stricture: Results from a large U.S. database

“…This disparity may be attributed to the laparoscopic system's advantages, which include superior visualization and precision during bladder neck reconstruction [31]- [33]. Such enhancements not only help in minimizing undue stress and traction from stitches on urethral tissues, but may also contribute to better bleeding control, ultimately leading to a shorter catheterization time [34], [35].…”

Prostatachirurgie beim benignen Prostatasyndrom >200 ml: Endoskopisch, robotisch oder doch offen?

“…Zum Vergleich der OSP mit der RAE bei großen Prostatavolumina gibt es aktuell nur sehr wenig Literatur. In einer Meta-Analyse von Xia et al [8] wurden 2021 beide Modalitäten zur operativen Therapie großer Prostatavolumina >80 ml miteinander verglichen. Es zeigte sich, dass die RAE ähnliche funktionelle Ergebnisse bei besserer klinischer Sicherheit aufwies.…”