Introduction: Simple prostatectomy is the treatment of choice for symptomatic benign prostatic hyperplasia (BPH), and it should be recommended in prostate glands >80cc. Although functional outcomes of the open approach (OSP) are undoubtedly favourable, the robotic approach (RASP) is gaining consensus thanks to its safety and reduced morbidity. However, data of RASP is scarce, and the majority of published series described small cohorts with short follow-up. We aimed to investigate perioperative outcomes of RASP and OSP in a large cohort of patients from two urological referral centres.
Methods: We analyzed data of 357 consecutive men with symptomatic BPH who received OSP or RASP at two referral centres [OLV Hospital (Aalst, Belgium) and United Hospitals (Ancona, Italy)] from 2011 to 2021. Multivariable regressions (MVA) investigated variables associated with postoperative complications after adjusting for age, Body Mass Index (BMI), Charlson Comorbidity Index (CCI), prostate volume, concurrent bladder stone or diverticula, indwelling catheter, surgical approach (OSP vs. RASP), operative time (OT) and estimated blood loss (EBL).
Results: A total of 201 (56%) and 156 (44%) men received OSP and RASP, respectively. Overall, median (interquartile range [IQR]) age and CCI were 70 (65-76) years and 3 (2-4), with no differences between the groups (both p>0.05). Median [IQR] prostate volume was slightly higher in the RASP vs. OSP group (median: 164 vs. 153 cc; p=0.08). As compared to men receiving OSP, OT was longer in the RASP group (124 vs. 89 minutes), with lower EBL (395 vs. 761 ml), shorter catheterisation time (3 vs. 10 days) and length of stay (LOS) (4 vs. 8 days; all medians; all p<0.001). The rate of overall post-operative complications was higher in the OSP vs. RASP group (33% vs. 24%; p=0.05), especially of Clavien-Dindo grade =3 (15% vs. 5%; p=0.003), with higher rates of postoperative blood transfusions (28% vs. 1%; p<0.001). On MVA, the probability of postoperative complications was higher for older men (odds ratio [OR]: 1.13; 95% confidence interval [CI]: 1.07, 1.23; p=0.047) and for men who had higher EBL (OR: 1.45; 95%CI: 1.02, 1.53; p=0.001), whereas the association between surgical approach and overall postoperative complications was not statistically significant (OR: 0.88; 95% CI 0.64, 1.27; p=0.1).
Conclusions: As compared to OSP, RASP allows for lower postoperative complications and blood transfusions and thus, it might be considered an option for the treatment of symptomatic BPH according to physician’s preference.
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