Outcomes of Robotic Simple Prostatectomy After Prior Failed Endoscopic Treatment of Benign Prostatic Hyperplasia - Beyond the Abstract

Our study represents the largest analysis on outcomes of transvesical, Retzius-sparing robot assisted simple prostatectomy (RASP) in primary versus redo settings. Our technique adds a 360 bladder neck reconstruction, in which the mucosa of the bladder neck is circumferentially reanastomosed to the apical urethra, circumventing the need for a large catheter and continuous irrigation. Ultimately, we found no differences in perioperative or functional outcomes between both groups. Our results show that our RASP technique is associated with improved urinary function outcomes and a low risk of postoperative complications in redo the management of symptomatic BPH.

RASP may be beneficial in the salvage setting for many reasons. The close circumferential enucleation performed during a RASP does not seem to be impacted by primary endoscopic treatment methods. The exposure during RASP allows for a clear appreciation of the adenoma-capsule plane, allowing the surgeon to perform a complete, standardized dissection in every case. Furthermore, as compared to transurethral therapies such as holmium laser enucleation of the prostate (HoLEP), RASP does not require torquing of rigid instruments across the sphincter or dilation of the urethra to any diameter higher than 18 French. This may reduce the risk of developing future urethral strictures seen with repeat transurethral approaches. Future studies comparing outcomes of RASP versus HoLEP in the retreatment setting may help highlight further pros and cons of each approach.

Written by: Matthew Lee, MD, MBA & Daniel Eun, MD, Temple University Hospital, Philadelphia, Pennsylvania, United States

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