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Introduction. The clinical guidelines recommend performing extended pelvic lymph node dissection for patients with intermediateor high-risk cancer prostate. The incidence of lymphocele development reaches 10.3%.Objective. The aim of this study was to evaluate the efficiency of the drug Lymphoblock after radical prostatectomy with pelvic lymphadenectomy.Materials & methods. The study involved 79 patients with prostate cancer who underwent robot-assisted radical prostatectomy with pelvic lymphadenectomy, that were randomized into three treatment groups: 1. Patients with free peritoneal flap fixed to the pubic bone (n = 26); 2. Patients who received Lymphoblock: during the surgery (n = 26); 3. Control group (n = 27). The median follow-up was 180 d.Results. In postoperative period lymphocele was diagnosed in 8 (10.1%) patients: group 1 — 2 (7.7%) patients, group 2 — 1 (3.8%), group 3 — 5 (18.5%). Lymphocele had no clinical manifestation in group patients who received Lymphoblock.Conclusions. Preliminary results of Lymphobloc use indicate that it can reduce the incidence of lymphogenic complications in the postoperative period in patients undergoing robot-assisted radical prostatectomy with pelvic lymphadenectomy.

Introduction. Prostate cancer (PCa) occupies a leading position in the structure of cancer incidence among men worldwide. The “gold standard” for the treatment of localised PCa is radical prostatectomy (RPE), with an increasing frequency of robot-assisted surgery in recent years. One of the negative consequences of surgery for the patient is the occurrence of urinary incontinence (UI), which is quite common and significantly reduces the quality of life. For this reason, it is extremely important to identify the factors that influence the occurrence of UI.Objectve. To identify risk factors for urinary incontinence in patients undergoing robot-assisted surgery based on the patients' preoperative data.Materials & methods. A prospective cohort study was conducted at the Urology Clinic of the Russian University of Medicine to study the risk factors for UI in patients undergoing robot-assisted RPE. The follow-up control points were set on days 1, 3, and 7 after urethral catheter removal and at 1, 3, 6, and 12 months after surgery. Anamnestic data and results of instrumental examination were analysed, based on which statistical analysis including logistic regression analysis with construction of regression equation was performed.Results. In the early postoperative period, UI occurred in 87 (70.3%) patients, but by the follow-up month 12, its frequency had decreased to 15 (11%) cases. Age, body mass index, length of the membranous urethra, size of the m. levator ani, history of prostate surgery and symptoms of an overactive bladder were predictors of UI. Based on the results, nomograms were created to calculate the probability of UI on day 7 and 1, 3, 6, 12 months after urethral catheter removal.Conclusion. The negative impact of UI on the quality of life of patients who have undergone RPE is obvious. Among the predictors identified by us, a modifiable group of risk factors for urinary incontinence was identified. This reduces the risk and severity of urinary incontinence after surgery, which will have a beneficial effect on the quality of life after surgery.

Introduction. Prostate cancer (PCa) is one of the most common cancers among men, and the tactic to treat this disease stage-depends directly. The “gold” standard for localized PCa is radical robot-assisted prostatectomy (RARP). Patients often have excessive surgery requirements and are concerned about the development of postoperative complications. One of the most frequent functional complications after this operation is urinary incontinence (UI), whose formation mechanism is not fully understood. Clinical studies have described many UI predisposing factors, but the results obtained are often contradictory, which requires a repeated and deeper study of the issue.Objective. To identify predisposing factors for urinary incontinence in patients undergoing radical robot-assisted prostatectomy.Materials & methods. The search results for the scientific databases PubMed, Medline, Web of Science, Embase, Cochrane Library and PEDro, Wang-fang Database and CNKI, Edline were analyzed for the queries "robot-assisted prostatectomy", "radical prostatectomy", "incontinence", "predictors", "urinary incontinence".Results. The predisposing factors to UI after RARP were studied. The review discusses and illustrates in detail all known predisposing factors for UI and shows the inconsistency of the data obtained by different researchers, which once again emphasizes the need for further study of this issue.Conclusion. Despite the long history of studying postoperative complications of RARP, reliable and consistent data on all the risks of UI after RARP have not yet been obtained. Therefore, this literature review summarizes and analyzes the results of the latest research in recent years.

Background and Objectives: Inguinal hernia (IH) is a usual finding in men with prostate cancer (PCa) due to their similar risk factors, such as age, gender, and smoking. This study aims to present a single institution's experience with simultaneous IH repair (IHR) and robotic-assisted radical prostatectomy (RARP). Materials and Methods: We retrospectively reviewed 452 patients who underwent RARP between January 2018 and December 2020. A total of 73 patients had a concomitant IHR with a monofilament polypropylene mesh. Patients with bowel in the hernia sac or recurrent hernia were excluded. Results: The median age and the American Society of Anesthesiologists (ASA) score were 67 years (inter-quartile range (IQR) 56–77) and 2 (IQR 1–3), respectively. The median prostate volume and preoperative prostate-specific antigen (PSA) were 38 mL (IQR 25.0–75.2) and 7.8 ng/mL (IQR 2.6–23.0), respectively. The surgery was successfully performed in all cases. The median overall and IHR operative time were 190.0 (IQR 140.0–230.0) and 32.5 (IQR 14.0–40.0) minutes, respectively. The median estimated blood loss and length of hospital stay were 100 mL (IQR 10–170) and 3 days (IQR 2–4), respectively. Only five (6.8%) minor complications occurred after surgery. At the 24-month follow-up, no cases of mesh infection, seroma formation, or groin pain were recorded. Conclusions: This study confirmed the safety and efficacy of performing simultaneous RARP and IHR. [ABSTRACT FROM AUTHOR]

Introduction In adults, rhabdomyosarcoma of the prostate is extremely rare and has an unfavorable prognosis. These patients frequently experience urinary obstruction, and cysto‐prostatectomy is a mainstay treatment for localized disease. In contrast, treatment strategies for the primary site for metastatic disease remain controversial. To our knowledge, robot‐assisted surgery for the primary tumor has not been reported. Case presentation A 26‐year‐old man complained of dysuria. Magnetic resonance imaging showed enlarged prostate and computed tomography revealed a pulmonary metastasis. Transurethral resection of the prostate led to the diagnosis of rhabdomyosarcoma. After chemotherapy, robot‐assisted prostatectomy was performed to relieve obstructive urinary symptoms. Although disease progression in the metastatic site was observed after the surgery, urinary obstruction did not occur and quality of life was well maintained. Conclusion Robot‐assisted prostatectomy may be beneficial both for local disease control and palliation of voiding impairment among selected patients with systemic rhabdomyosarcoma of the prostate.

We assessed whether the severity of anastomotic urinary leakage detected during routine cystourethrography after robot-assisted laparoscopic prostatectomy (RALP) affects urinary continence recovery. Around 302 patients who underwent RALP between August 2013 and May 2019 were included retrospectively. According to routine cystourethrographic findings obtained on the sixth or eighth postoperative day, which indicated leakage severity, patients were divided into three groups: no-leakage, grade 1 (linear shaped leakage, but not spreading), and grade 2 (spreading strip-shaped leakage). The preoperative factors and intraoperative factors were compared between no-leakage and leakage group (grade 1 and grade 2). Continence recovery was compared between the three groups. Continence recovery was defined as no pad used or one security pad used in a day. Cystourethrography revealed anastomotic urinary leakage in 44 patients (14.5%), of which 20 patients (6.6%) had grade 1 leakage and 24 patients (7.9%) had grade 2 leakage. On multivariate logistic regression analysis, the only significant predictor for urethrovesical anastomotic urinary leakage on cystourethrography following RALP was intraoperative anastomotic leakage (OR 5.306; 95% CI 1.530–18.398, p = 0.009). Continence recovery rates for no-leakage, grade 1 leakage, and grade 2 leakage groups were 11%, 20%, and 25% after 1 month (P = 0.131); 25%, 25%, and 45.8% after 3 months (P = 0.474); 44.6%, 55%, and 60.8% after 6 months (P = 0.184); and 63.1%, 87.5%, and 78.2% after 12 months (P = 0.095), respectively. In conclusion, urinary leakage in urethrovesical anastomosis, even at its severity, had no negative effects on continence recovery after RALP. [ABSTRACT FROM AUTHOR]

Background. Considering decreasing age of patients with prostate cancer, increasing cancer alertness of first-line doctors as well as increased frequency of radical prostatectomies (RP), the problem of preservation of erectile function (EF) is vitally important (erectile dysfunction develops in 25–75 % of all patients who underwent surgery).The study objective is to analyze preservation of EF after RP depending on the type of endoscopic access and nerve preservation.Materials and methods. Between February of 2015 and February of 2016, in the Urology Clinic of the Sechenov University, 507 RPs were performed; the retrospective single-center study included 231 patients with localized prostate cancer. Surgery was performed with the following accesses: laparoscopic, extraperitoneal laparoscopic, and robotic. Indications for nerve preservation were formulated based on the Briganti nomogram, Partin table as well as patient’s desire to preserve EF. Further evaluation of EF was performed using the International Index of Erectile Function (IIEF5), evaluation of quality of life – using the QoL (Quality of Life) scale.Results. RP with nerve preservation was performed in 150 patients. Surgical time and blood loss did not significantly differ for surgeries with and without nerve preservation (р = 0.064 and р = 0.073 respectively). Pathomorphological examination showed that in all cases (n = 231) integrity of the prostatic capsule and negative surgical margin were achieved. Frequent significant erectile dysfunction and full loss of EF were observed in patients after RP without nerve preservation compared to the group with preserved neurovascular bundles (5.0 (0.0–10.0) points compared to 6.5 (0.8–19.0) points per the IIEF5 scale, р = 0.271): 96.2 % versus 72.2 % (p

Objectives: To assess the effects of posterior musculofascial reconstruction robot‐assisted laparoscopic prostatectomy (PR‐RALP) compared to no PR during standard RALP (S‐RALP) for the treatment of clinically localised prostate cancer. Patients and Methods: We performed a systematic search with no restrictions including randomised controlled trials (RCTs) comparing variations of PR‐RALP vs S‐RALP for clinically localised prostate cancer. The quality of evidence was assessed on outcome basis according to Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. Our search identified 13 records of eight unique RCTs, of which six were published studies, and two were abstract proceedings. There were 1085 randomised patients, of whom 963 completed the trials. All patients had either cT1c or cT2 or cT3a disease. Results: A PR‐RALP may improve urinary continence 1 week after catheter removal compared to no PR (risk ratio [RR] 1.25, 95% confidence interval [CI] 0.90–1.73; I2 = 42%, five studies, 498 patients, low certainty of evidence [CoE]). A PR‐RALP may have little to no effect on urinary continence 3 months after surgery compared to no PR (RR 0.98, 95% CI 0.84–1.14; I2 = 67%, six studies, 842 patients, low CoE). A PR‐RALP probably results in little to no difference in serious adverse events compared to no PR (RR 0.75, 95% CI 0.29–1.92; I2 = 0%, six studies, 835 patients, moderate CoE). Conclusions: This review found evidence that PR‐RALP may improve early continence 1 week after catheter removal but not thereafter. Meanwhile, adverse event rates are probably not impacted and positive surgical margin rates are likely similar. There was no difference in our subgroup analysis for all outcomes with anterior reconstruction technique when combined with PR vs only PR. [ABSTRACT FROM AUTHOR]

Background and Objectives: Inguinal hernia (IH) is a usual finding in men with prostate cancer (PCa) due to their similar risk factors, such as age, gender, and smoking. This study aims to present a single institution’s experience with simultaneous IH repair (IHR) and robotic-assisted radical prostatectomy (RARP). Materials and Methods: We retrospectively reviewed 452 patients who underwent RARP between January 2018 and December 2020. A total of 73 patients had a concomitant IHR with a monofilament polypropylene mesh. Patients with bowel in the hernia sac or recurrent hernia were excluded. Results: The median age and the American Society of Anesthesiologists (ASA) score were 67 years (inter-quartile range (IQR) 56–77) and 2 (IQR 1–3), respectively. The median prostate volume and preoperative prostate-specific antigen (PSA) were 38 mL (IQR 25.0–75.2) and 7.8 ng/mL (IQR 2.6–23.0), respectively. The surgery was successfully performed in all cases. The median overall and IHR operative time were 190.0 (IQR 140.0–230.0) and 32.5 (IQR 14.0–40.0) minutes, respectively. The median estimated blood loss and length of hospital stay were 100 mL (IQR 10–170) and 3 days (IQR 2–4), respectively. Only five (6.8%) minor complications occurred after surgery. At the 24-month follow-up, no cases of mesh infection, seroma formation, or groin pain were recorded. Conclusions: This study confirmed the safety and efficacy of performing simultaneous RARP and IHR.

Introduction: An inguinal hernia is frequently identified in men with prostate cancer, which is likely due to similar risk factors, including age, gender and smoking., Aim: To assess the safety and feasibility of performing concomitant robotic-assisted radical prostatectomy (RARP) and robotic-assisted transabdominal preperitoneal (TAPP) inguinal hernia repair., Materials and Methods: We retrospectively analyzed the treatment outcomes of 23 patients who underwent RARP between January 2022 and June 2023. All patients underwent RARP and robotic-assisted TAAP inguinal hernia repair using a polypropylene mesh implant., Results: The mean age was 70 years. Median prostate volume and preoperative prostate-specific antigen (PSA) were 52 ml and 8.0 ng/ml, respectively. In all cases the procedure was successful. The mean total duration of RARP and inguinal hernia repair was 147.17 and 26.01 minutes, respectively. The mean estimated blood loss and length of hospital stay was 171.96 mL and 7 days, respectively. In nine cases there was Clavien-Dindo grade 1 complications in the postoperative period; all complications were resolved conservatively. At a median follow-up of 12 months, there were no cases of mesh infection, seroma formation, or inguinal pain., Conclusions: Our results confirm the safety and feasibility of simultaneous RARP and robot-assisted TAPP inguinal hernia repair.

Despite multiple studies evaluating the effectiveness of Robot-Assisted Radical Prostatectomy (RARP), there is no definitive conclusion about the added value of RARP. A retrospective cluster study was conducted to evaluate long-term sexual and urinary functioning after RARP and Laparoscopic Radical Prostatectomy (LRP) based on real-world data from 12 Dutch hospitals. Data was collected from patients who underwent surgery between 2010 and 2012. A mixed effect model was used to evaluate differences between groups on urinary and sexual functioning (EPIC-26). Additionally, a regression analysis was conducted to evaluate the relationship between these functional outcomes and, among others, hospital volume. 1370 (65.1%) patients participated, 907 underwent RARP and 463 LRP, with a median follow-up time of 7.08 years (SD = 0.98). The RARP group showed a statistically and clinically significant better urinary functioning compared to the LRP group (p = 0.002). RARP showed also a shorter procedure time (p=<0.001), reduced blood loss (p=<0.001), and a higher chance of neurovascular bundle preservation (39.8% vs 29.1%; p=<0.01). RARP resulted in better long-term urinary function compared to LRP. Based on the results from this study, guidelines concerning the preferred surgery type and the position on reimbursement may change, especially when RARP proves to be cost-effective. [ABSTRACT FROM AUTHOR]

Introduction The aim of this article was to analyze whether operative time and blood loss during radical prostatectomy (RP) can significantly influence surgical margins (SM) status and post-operative functional outcomes. Material and methods We prospectively analyzed prostate cancer (PC) patients undergoing RP, using robot-assisted (RARP) or laparoscopic (LRP) procedures. Blood loss was defined using the variation in hemoglobin (Hb, g/dl) values from the day before surgery and no later than 4 hours after surgery. Results From a whole population of 413 cases considered for RP, 67% underwent LRP and 33.0% RARP. Positive SM (SM+) were found in 33.9% of cases. Mean surgical operative time was 172.3 ±76 min (range 49-485), whereas blood loss was 2.3 ±1.2 g/dl (range 0.3-7.6). Operative time and blood loss at RP were not significantly correlated (r = -0.028275; p = 0.684). SM+ rates significantly (p = 0.002) varied by operative time; a higher SM+ rate was found in cases with an operative time <120 min (41.2%) and >240 min (53.4%). The risk of SM+ significantly increased 1.70 and 1.94 times in cases with an operative time <120 min and >240 min, respectively, independently to the surgical approach. The rate of erectile disfunction (ED) varied from 22.4% to 60.3% between <120 min and >240 min procedures (p = 0.001). According to blood loss, SM+ rates slightly but significantly (p = 0.032) varied; a higher rate of SM+ was found in cases with a Hb variation between 2-4 g/dl (35.9%). Conclusions Independently to the surgical approach, operative time, more than blood loss at RP, represents a significant variable able to influence SM status and post-operative ED. [ABSTRACT FROM AUTHOR]

A duplicated collecting system is a common congenital anomaly of the urinary tract. However, late symptomatic presentation in adulthood is uncommon. We report the first case of left heminephrectomy, ureterectomy and radical prostatectomy using the da Vinci SP (single port) surgical system in a 64-year-old patient with localized prostate cancer and duplicated system with ectopic ureteral insertion into the prostatic urethra. The procedure was completed without technical difficulties or intraoperative adverse events. We demonstrate that the da Vinci SP robot allows for efficient performance of concomitant surgeries on the kidney and prostate without the limitations reported with single site surgeries.

Introduction The aim of this study was to analyze whether differences exist in a population selected for a nerve-sparing (NS) procedure between robot-assisted (RARP) and laparoscopic radical prostatectomy (LRP), and whether they can have an impact on surgical margins (SM) status. Material and methods This is a single center prospective comparative trial on prostate cancer patients submitted to a RARP-NS or LRP-NS. A self-administered questionnaire on expectations before surgery, and level of satisfaction after surgery was used. Results A total of 134 cases were included in our analysis. A higher percentage of capsular bulging was found in the RARP group, compared to the LRP group (p = 0.077). At biopsy, the percentage of positive cores and multifocality were higher in the RARP group (p = 0.005). Positive SM (SM+) rate was higher in the RARP, than in LRP group (p = 0.046). On univariable analysis, the risk of SM+ increased 1.95 times using RARP when compared with LRP. On multivariable analysis, the surgical approach did not maintain a significant predictive role in terms of risk for SM+. Expectations before surgery were mainly focused on oncological radicality, however in the RARP group a higher percentage of cases focused on sexual function recovery. Satisfaction after surgery was lower in the RARP than in the LRP group. Conclusions Comparing LRP-NS with RARP-NS in a high-volume single center, the expectation/satisfaction ratio is in favor of LRP. Worse oncologic preoperative characteristics in the RARP group may influence the higher incidence of SM+. However, the surgical approach does not result as a significant and independent factor able to influence SM positivity. [ABSTRACT FROM AUTHOR]

Purpose: Several studies have compared the short-term outcomes of extraperitoneal robot-assisted laparoscopic radical prostatectomy (EP-RALP) and transperitoneal RALP (TP-RALP). The study was designed to evaluate the long-term outcomes of the two methods.Materials and Methods: A prospective, non-randomized study was conceived. The demographics and operative outcomes of patients with prostate cancer undergoing RALP from September 2016 to January 2017 at our center were included.Results: A total of eighty-six patients were enrolled. Thirty-seven patients underwent EP-RALP, and forty-nine patients received TP-RALP. No significant difference was observed in age, body mass index, pathological T stage, pathological N stage, M stage, 2014 International Society of Urological Pathology group, comorbidities or American Society of Anesthesiologists score. A lower preoperative prostate-specific antigen (PSA) was detected in the EP-RALP group. No significant differences were observed in overall operation time, robotic console time, surgical margin status, postoperative hospitalization time, drop of hemoglobin and complications, except that patients with EP-RALP had a shorter time to first exsufflation after surgery than those with TP-RALP (41.35 vs. 51.80 h, P < .001). Postoperative PSA until 12 months was deemed comparable in both groups. Complete continence until 12 months after surgery was desirable but not significantly different between two groups (75.0% in EP- RALP vs. 86.7%. in TP-RALP, P = .179).Conclusion: The long-term outcomes of EP-RALP were analogous to those of TP-RALP. Therefore, EP-RALP is an alternative approach for patients with localized prostate cancer. [ABSTRACT FROM AUTHOR]

Objective: To investigate the influence of tumour location zone on positive surgical margin (PSM) status after Retzius‐sparing robot‐assisted radical prostatectomy (RS‐RARP). Materials and Methods: A total of 203 consecutive patients with prostate cancer (PCa) who underwent RS‐RARP at our centre were divided into three cohorts according to the tumour zonal origin described on preoperative magnetic resonance imaging (MRI). Clinical and pathological characteristics were compared among the three groups. The associations of clinicopathological variables with PSM status after RS‐RARP were also evaluated. Results: The rates of PSM in patients with transition zone (TZ) and mixed origin tumours were significantly higher than in patients with peripheral zone tumours (P < 0.01). Of the PSMs in patients with TZ and mixed origin cancers, 42.0% and 40.9%, respectively, were located at the anterior part of the gland. On multivariate analysis, presence of a TZ tumour was significantly associated with a higher PSM rate after RS‐RARP (P < 0.01). Sub‐analysis showed that high‐risk patients with TZ tumours had a higher risk of PSM after RS‐RARP (P < 0.01). Conclusion: Presence of a TZ tumour is an independent risk factor for PSMs after RS‐RARP. Preoperative identification of TZ tumours might aid surgical planning for the Retzius‐sparing technique, especially in high‐risk patients. [ABSTRACT FROM AUTHOR]

Purpose: To assess the oncologic results of our robot-assisted laparoscopic prostatectomy (RALP) cases and investigate whether the learning curve (LC) affects the oncological outcomes.  Materials and Methods: Between March 2015 and September 2017, 111 patients underwent RALP by a single surgeon in our clinic. The learning curve was analyzed using the moving average method. We compared the rate of positive surgical margins(PSM) and oncological outcomes, operation times, hematocrit changes and duration of hospitalization among the patients during and after the LC. Complications were also noted according to Clavien system.Results: LC analysis using the moving average method showed that the LC stabilized between cases 51-60. So, patients were classified into two groups; 1-50 cases (Group 1) and 51-111 cases (Group 2). PSM rates were 36% for group 1 and 18% for group 2, and statistically different (p=0,032). Extracapsular invasion (ECI) was significantly higher in group 1 (56,5%) than in group 2 (29,5%) (p=0,005). Multiple logistic regression analysis revealed that presence of ECI was an independent factor for PSM associated with the groups (OR: 2.512; 95% CI: 1.055-5.979). Both operation time and duration of postoperative hospitalization were significantly reduced from group 1 to group 2. A total of 11 patients (10%) had complications and one of them (0,9%) required surgical intervention.Conclusion: We can conclude that at least 50 RALP cases are needed to gain proficiency even for an experienced surgeon in laparoscopic radical prostatectomy. Our study demonstrates that surgeons experience can affect the perioperative variables but the LC does not affect PSM status in RALP. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to investigate the safety and patients’ benefit of incidental appendectomy during robot-assisted laparoscopic radical prostatectomy (RALRP).Methods: Fifty-three patients, who had incidental appendectomy during RALRP between January 2012 and March 2014, were enrolled to this study. To evaluate the safety of the procedure, following parameters were evaluated: patient age, duration of surgery, perioperative complications (classified by Clavien-Dindo), time to bowel movement, and length of hospital stay. Furthermore, intraoperative visual appearance, location, and histopathological evaluation of the appendix were evaluated. Data was analyzed by descriptive statistics.Results: Mean age of patients was 61 years, the average hospital stay 5 days. No perioperative complications occurred. The appendix was unsuspicious in 39 patients (73.6%); 14 patients (26.4%) had macroscopically signs of inflammation.Of the 53 resected appendixes, the histopathological evaluation showed 33 (62.2%) inconspicuous appendices, 11 (20.8%) post-inflammatory changes, 4 (7.5%) with chronical signs of inflammation and 3 (5.7%) with signs of acute inflammation. In 2 patients (3.8%), low-grade mucinous neoplasms were found in the specimens.Conclusions: Incidental appendectomy during RALRP is a feasible procedure. With regard to inflammation and neoplastic changes, incidental appendectomy can be considered for patients scheduled for robot-assisted prostate surgery. [ABSTRACT FROM AUTHOR]

Neglected side effects after radical prostatectomy have been previously reported. In this context, the prevalence of penile morphometric alterations has never been assessed in robot-assisted radical prostatectomy series. We aimed to assess prevalence of and predictors of penile morphometric alterations (i.e. penile shortening or penile morphometric deformation) at long-term follow-up in patients submitted to either robot-assisted (robot-assisted radical prostatectomy) or open radical prostatectomy. Sexually active patients after either robot-assisted radical prostatectomy or open radical prostatectomy prospectively completed a 28-item questionnaire, with sensitive issues regarding sexual function, namely orgasmic functioning, climacturia and changes in morphometric characteristics of the penis. Only patients with a post-operative follow-up ≥ 24 months were included. Patients submitted to either adjuvant or salvage therapies or those who refused to comprehensively complete the questionnaire were excluded from the analyses. A propensity-score matching analysis was implemented to control for baseline differences between groups. Logistic regression models tested potential predictors of penile morphometric alterations at long-term post-operative follow-up. Overall, 67 (50%) and 67 (50%) patients were included after open radical prostatectomy or robot-assisted radical prostatectomy, respectively. Self-rated post-operative penile shortening and penile morphometric deformation were reported by 75 (56%) and 29 (22.8%) patients, respectively. Rates of penile shortening and penile morphometric deformation were not different after open radical prostatectomy and robot-assisted radical prostatectomy [all p > 0.5]. At univariable analysis, self-reported penile morphometric alterations (either penile shortening or penile morphometric deformation) were significantly associated with baseline international index of erectile function-erectile function scores, body mass index, post-operative erectile function recovery, year of surgery and type of surgery (all p < 0.05). At multivariable analysis, robot-assisted radical prostatectomy was independently associated with a lower risk of post-operative penile morphometric alterations (OR: 0.38; 95% CI: 0.16-0.93). Self-perceived penile morphometric alterations were reported in one of two patients after radical prostatectomy at long-term follow-up, with open surgery associated with a potential higher risk of this self-perception. [ABSTRACT FROM AUTHOR]

In an editorial board-moderated debate format, two experts in prostate cancer surgery are challenged with presenting the key strategies in radical prostatectomy that improve urinary functional outcomes. Dr Bernardo Rocco was tasked with arguing the facts that support the anatomical preservation and reconstruction steps that improve urinary continence. Drs Christian Pavlovich and Sasha Druskin were tasked with arguing the facts supporting neurovascular bundle and high anterior release surgical planes that improve urinary continence. Associate Editor John Davis moderates the debate, and outlines the current status of validated patient questionnaires that can be used to evaluate urinary continence, and recent work that allows measuring what constitutes a 'clinically significant' difference that either or both of these surgical techniques could influence. A review of raw data from a publication from Dr Pavlovich's team demonstrates how clinically relevant differences in patient-reported outcomes can be correlated to technique. A visual atlas is presented from both presenting teams, and Dr Davis demonstrates further reproducibility of technique. A linked video on this concept is available as a supplementary file. [ABSTRACT FROM AUTHOR]

Background: The utilization and extent of pelvic lymph node dissection (PLND) varies depending on the disease and practice patterns.Aims: This study compares practice patterns in utilization of PLND between Indian and United States (US) practices.Settings and Design: We focused on 415 patients (204 India; 211 US) prostate cancer patients treated with robot-assisted radical prostatectomy, between 2015 and 2016, within the Vattikuti Collective Quality Initiative database.Subjects and Methods: Utilization of PLND and number of nodes removed were evaluated for the entire cohort, and after stratifying for Country of treatment and D'Amico risk groups. Logistic regression tested the relationship between PLND and country of treatment, after adjusting for disease risk.Results: Indian patients had a higher risk distribution (D'Amico high-risk 53.4% in India vs. 27% in the US; P< 0.001) compared to their US counterparts. Overall, 193/204 (94.6%) Indian patients underwent PLND versus 181/211 (85.8%) US patients (P = 0.003). When stratified based on disease risk, PLND was performed more frequently in Indian patients with low-risk disease (81.0% vs. 41.4%,P= 0.008), but not in those with intermediate and high-risk disease. On multivariable analysis, Indian patients had a 2.57-fold higher probability of undergoing PLND than their US counterparts (P = 0.02). The analysis of the number of lymph nodes removed showed similar trends.Conclusions: Indian patients are more likely to undergo PLND than US patients. This is, especially true for patients with low-risk disease, who are unlikely to benefit from this procedure. Efforts should focus on optimizing the utilization of PLND, and deliver it only when there is clinical indication. [ABSTRACT FROM AUTHOR]

In 2020, prostate cancer (PCa) ranked third in the structure of the most significant oncological diseases. In the Russian Federation, in terms of the frequency of detection among men, prostate cancer is second only to tumors of the upper respiratory tract and lungs, accounting for 14.9%. Radical prostatectomy (RP) in various modifications is still the most common treatment for localized prostate cancer, despite the existence of alternatives such as active surveillance, hormonal and radiation therapy, cryoablation, and others. And the technological pinnacle of the surgical treatment of prostate cancer at the moment is robot-assisted prostatectomy, the widespread use of which was marked by the publication of J. Binder back in 2002. This technology combined the advantages of minimally invasive laparoscopic RP with improved surgeon ergonomics and technical ease of vesicourethral anastomosis reconstruction and has now become the preferred minimally invasive approach. This article will consider the use of a robot-assisted technique in the stage of T3 prostate cancer.

Introduction: Prostate cancer (PCa) occupies a leading position in the structure of oncological morbidity and mortality and is an urgent problem of modern oncourology. In recipients after organ transplantation, due to the intake of immunosuppressants, the risk of aggressive forms of cancer increases, which necessitates active treatment. In the world, there is not enough data on the radical treatment of PCa in patients after heart transplantation (HT), especially on surgical treatment. We present the first experience in Russia and Eastern Europe of 3 robot-assisted radical prostatectomy for localized PCa in patients after HT., Materials and Methods: The procedures were performed from February 2021 to November 2021 at the FGBU NMRC named after V.A. Almazov. Preoperative preparation, as well as postoperative management of patients was carried out jointly by urologists and transplant cardiologists., Results: The main demographic, perioperative indicators, as well as oncological and non-oncological outcomes are presented. All patients were discharged from the hospital in a satisfactory condition. During the follow-up period, there were no biochemical recurrences of PCa. Early urinary continence in all three patients was satisfactory., Conclusion: Thus, robot-assisted radical prostatectomy in patients after HT is a technically feasible, effective, and safe treatment for PCa. The comparative studies with prolonged follow-up are needed.

Objective:This study aimed to assess the role of tadalafil, a phosphodiesterase type 5 inhibitor (PDE5-I), in recovery of lower urinary tract symptoms (LUTS) after robot-assisted radical prostatectomy (RARP). Materials and methods:All patients treated with RARP between October 2010 and August 2013 were enrolled in this retrospective study on prospectively collected data. Patients were retrospectively divided into groups according to postoperative treatment: patients taking tadalafil twice weekly from 1 month to 6 months after RARP, and patients not taking tadalafil. The International Prostate Symptom Score (IPSS), the Overactive Bladder Symptom Score (OABSS) and urinary continence (UC) were assessed preoperatively (2 days before RARP) and at 1, 3, 6, 9 and 12 months after RARP. Results:There was no difference in the overall IPSS score between the groups. At 6 and 9 months, the IPSS storage symptom scores were significantly lower in patients taking tadalafil than in patients not taking tadalafil. In patients with overactive bladder (OAB) before RARP (n = 22), no differences in the total scores of OABSS were seen between patients taking tadalafil and patients not taking tadalafil. On the other hand, in non-OAB patients before RARP (n = 68), at 3, 6 and 9 months, the total scores of OABSS were significantly lower in patients taking tadalafil than in patients not taking tadalafil. No differences in UC rates after surgery were seen between the groups. Conclusion:Postoperative tadalafil treatment may be temporarily effective for the recovery of the IPSS storage symptom scores and OABSS. [ABSTRACT FROM PUBLISHER]

Purpose: To evaluate differences in health related quality of life and time to return to normal activities between patients treated with open radical prostatectomy (ORP) and robotassisted radical prostatectomy (RARP). Patients and Methods: Three hundred and two patients treated with RARP or ORP were prospectively enrolled. One year after surgery, patients received a questionnaire to evaluate social life, duration of being limited in daily and sexual life as well as satisfaction with the treatment. Results: Both cohorts showed no differences in age, prostate specific-antigen-levels, Gleason score, prostate volume or T-stage (p > 0.05). Median blood loss was significant lower and the surgical time was significant higher in the RARP group. There were no significant differences regarding the duration of being limited in social or daily life or regarding the satisfaction with the treatment. The median time patients felt affected in their work was 2 months. There were no significant differences in terms of subjective global health status and HrQoL 3 months (p = 0.60 and p = 0.40) and 6 months (p = 0.30 and p = 0.20) after surgery. Conclusion: The present study confirms significant perioperative benefits for patients undergoing RARP compared to ORP. However, there is no difference in HrQoL as well as in the time to return to normal activities between patients treated with RARP and ORP. [ABSTRACT FROM AUTHOR]

BACKGROUND: Our aim was to compare both the perioperative and the short/medium-term post-operative oncological results after radical prostatectomy between two groups of prostate cancer patients: one group treated with radical retropubic prostatectomy (RRP), the other one with robot-assisted laparoscopic prostatectomy (RALP). METHODS: We collected all the clinical, surgical, pathological and follow-up data of the patients who underwent radical prostatectomy with the two different surgical methods in a dedicated database. The positive surgical margins were defined by the presence of disease at the resection margin marked with China ink. The biochemical persistence of disease was defined as a PSA value >0.1 ng/mL 30 days after surgery, while the biochemical recurrence of the neoplasia was defined as a PSA value >0.2 ng/mL. RESULTS: The positive surgical margins (PSM) were identified as follows: 29.3% (RRP) versus 25.4% (RALP) in pT2 cancer (p 0.563), and 63.6% (RRP) versus 50.0% (RALP) in case of >pT2 cancer (p 0.559). If stratified by surgical approach, the results are: 53.3% (RRP) versus 25.6% (RALP) (p <0.001) in case of nerve-sparing technique. The persistence of disease is detectable in 5.4% (RRP) versus 4.6% (RALP), while the data on biochemical recurrence are: 2.7% (RRP) versus 0% (RALP). CONCLUSIONS: In our experience, in two groups of patients matched for clinic-pathological features who underwent RRP and RALP, oncological results are slightly better in the second group; this figure is even more significant when evaluating surgeries conducted with nerve-sparing technique. In this study we analyzed data of RALP, recently introduced in our center, comparing with RRP, a surgical technique consolidated through the decades. Therefore it can be said that even during the learning curve, RALP provides oncological results comparable to RRP. [ABSTRACT FROM AUTHOR]

Introduction: Robot-assisted radical prostatectomy (RARP) has first been performed in 2000 and has since then become a widespread and often performed therapy option for surgical treatment of prostate cancer. The purpose of this review was to highlight the current clinical concepts for radical prostatectomy. Discussion and conclusions: Actual literature search was performed in PubMed database and reviewed. Different surgical techniques for RARP are presented. Oncologic and functional outcomes of RARP are discussed and compared to radical retropubic prostatectomy. In conclusion, RARP has equal oncologic and functional outcome in localized prostate cancer. RARP as a less invasive treatment option for patients with localized prostate cancer should be considered as a new standard of care by now. [ABSTRACT FROM AUTHOR]

Lack of randomized controlled trials (RCTs) that compare pure laparoscopic radical prostatectomy (LRP) with robot-assisted laparoscopic radical prostatectomy (RALRP) is an important gap of the literature related to the surgical treatment of the clinically localized prostate cancer (PCa). To provide the first prospective randomized comparison on the functional and oncological outcomes of LRP and RALRP for the treatment of the clinically localized PCa. Between 2007 and 2008, 128 consecutive male patients were randomized in two groups and treated by a single experienced surgeon with traditional LRP (Group I-64 patients) or RALRP (Group II-64 patients) in all cases with intent of bilateral intrafascial nerve sparing. Primary end point was to compare the 12 months erectile function (EF) outcomes. Complication rates, continence outcomes, and oncological results were also compared. The sample size of our study was able, with an adequate power (1-beta > 0.90), to recognize as significant large differences (above 0.30) between incidence proportions of considered outcomes. No statistically significant differences were observed for operating time, estimated blood loss, transfusion rate, complications, rates of positive surgical margins, rates of biochemical recurrence, continence, and time to continence. However, the 12-month evaluation of capability for intercourse (with or without phosphodiesterase type 5 inhibitors) showed a clear and significant advantage of RALRP (32% vs. 77%, P < 0.0001). Time to capability for intercourse was significantly shorter for RALRP. Rates of return to baseline International Index of Erectile Function (IIEF-6) EF domain score questionnaires (questions 1-5 and 15) (25% vs. 58%) and to IIEF-6 > 17 (38% vs. 63%) were also significantly higher for RALRP ( P = 0.0002 and P = 0.008, respectively). Our study offers the first high-level evidence that RALRP provides significantly better EF recovery than LRP without hindering the oncologic radicality of the procedure. Larger RCTs are needed to confirm if a new gold-standard treatment in the field of RP has risen. [ABSTRACT FROM AUTHOR]

Abstract: Background: Observational data indicate that retropubic radical prostatectomy (RRP) for prostate cancer (PCa) may induce inguinal hernia (IH) formation. Little is known about the influence of robot-assisted radical prostatectomy (RALP) on IH risk. Objective: To compare the incidence of IH after RRP and RALP to that of nonoperated patients with PCa and to a population control. Design, setting, and participants: We studied two groups. All 376 men included in the Scandinavian Prostate Cancer Group Study Number 4 constitute study group 1. Patients were randomly assigned RRP or watchful waiting (WW). The 1411 consecutive patients who underwent RRP or RALP at Karolinska University Hospital constitute study group 2. Men without PCa, matched for age and residence to each study group, constitute controls. Measurements: Postoperative IH incidence was detected through a validated questionnaire. The participation rates were 82.7% and 88.4% for study groups 1 and 2, respectively. Results and limitations: The Kaplan-Meier cumulative occurrence of IH development after 48 mo in study group 1 was 9.3%, 2.4%, and 0.9% for the RRP, the WW, and the control groups, respectively. There were statistically significant differences between the RRP group and the WW and control groups, but not between the last two. In study group 2 the cumulative risk of IH development at 48 mo was 12.2%, 5.8%, and 2.6% for the RRP, the RALP, and the control group, respectively. There were statistically significant differences between the RRP group and the RALP and control groups, but not between the last two. Conclusions: RRP for PCa leads to an increased risk of IH development. RALP may lower the risk as compared to open surgery. [ABSTRACT FROM AUTHOR]

Abstract: Background: Puboprostatic ligament preservation has been proposed as a method to accelerate continence recovery after radical prostatectomy (RP). However, these ligaments present anatomic continuity with the bladder, and there must be interruption at some point to expose the prostatourethral junction. Objectives: To describe the surgical steps of pubovesical complex (PVC)–sparing robot-assisted laparoscopic RP (RALP) and present the preliminary results of our technique. Design, setting, and participants: Thirty PVC-sparing RALP procedures were performed in patients <60 yr with clinically localised prostate cancer between 2007 and 2009 by the same surgeon. Surgical procedure: The principles of bladder neck preservation, tension and energy-free dissection of the bundles as well as seminal vesicle sparing are applied. Ventrally, a plane of dissection is developed between the detrusor apron and the prostate. The soft connective tissue between Santorini''s plexus and the prostate is blandly dissected, leaving the plexus intact and in place. Measurements: The rates and location of positive surgical margins (PSM) as well as functional outcomes are presented. Results and limitations: Three of 30 patients (10%) had a PSM (two apical margins and one on the left posterolateral side). At catheter removal, 24 of 30 patients (80%) were dry (0 pads), and 6 of 30 patients (20%) needed one security pad. After 3 mo, 22 of 30 patients (73%) presented an International Index of Erectile Function score >17 (with or without phosphodiesterase type 5 inhibitors). Thirteen of 22 potent patients had an Erection Hardness Score of 3, and 9 of 22 patients had a score of 4. Small sample size, low mean age of enrolled patients (52 yr), and the absence of diseases that could impair the continence and potency recovery are some of the limitations of the study. Moreover, it is difficult to quantify the effect of each applied continence-sparing technique. Conclusions: The holistic preservation of the PVC during RALP is technically feasible. It leads towards an absolute preservation of the periprostatic anatomy that may enhance early functional outcomes. Further studies are needed to confirm our results. [Copyright &y& Elsevier]

Study Type – Therapy (case series) Level of Evidence 4 OBJECTIVE To evaluate factors that affect compliance in men who enrol in a phosphodiesterase type 5 inhibitor (PDE5I) protocol after nerve-sparing robot-assisted prostatectomy (RAP), and report on short-term outcomes, as PDE5Is may help restore erectile function after RAP and patient adherence to the regimen is a factor that potentially can affect outcome. PATIENT AND METHODS We prospectively followed 77 men who had nerve-sparing RAP and enrolled in a postoperative penile rehabilitation protocol. The men received either sildenafil citrate or tadalafil three times weekly. The minimum follow-up was 8 weeks. Potency was defined as erection adequate for penetration and complete intercourse. Compliance was defined as men adhering to the regimen for ≥2 months. RESULTS The mean age of the cohort was 57.8 years and the median follow-up was 8 months. In all, 32% of the men discontinued the therapy <2 months after RAP and were deemed noncompliant with an additional 39% discontinuing therapy by 6 months, with the high cost of medication being the primary reason (65%). Long-term compliance and preoperative erectile dysfunction were independent predictors of potency return after adjusting for age and nerve sparing. CONCLUSIONS The high cost of medication remains a significant barrier to maintaining therapy. Noncompliance to PDE5I therapy in a tertiary care centre was much higher than reported in clinical trial settings. With longer-term follow-up, we need to further define the factors that improve overall recovery of sexual function after RAP. [ABSTRACT FROM AUTHOR]

Abstract: Study Objective: To compare anesthetic management and postoperative outcomes in patients undergoing robot-assisted laparoscopic radical prostatectomy (RALP) and radical retropubic prostatectomy (RRP) with general anesthesia. Design: Retrospective database study of RALP and RRP patients at Duke University Medical Center from 6/2003 to 6/2006. Setting: University teaching hospital. Patients: 541 ASA physical status I, II, and III men, 280 of whom were RRP patients and 256 RALP patients. Measurements: Patient demographics, intraoperative fluids and blood products, hemodynamic parameters, pain scores in the Postanesthesia Care Unit (PACU), intraoperative and postoperative analgesic consumption, need for rescue antiemetics in the PACU, and intraoperative use of vasopressors and antihypertensives, were all recorded. Additional data included postoperative transfusion data; clinical status of the patient''s cancer preoperatively and postoperatively; hematocrit, platelet count, and creatinine levels; and length of hospital stay. Main Results: Estimated blood loss (EBL) was higher for RRP than RALP patients (mean ± SD; 1,087 ± 853 mL vs. 287 ± 317 mL; P < 0.0001). Likewise, 24% of RRP patients received red blood cell (RBC) transfusions intraoperatively, compared with 0.4% RALP patients (P < 0.0001). Intraoperatively, RALP patients received more antihypertensive agents (37% vs. 21%; P < 0.0001), and fewer vasopressors (63% vs. 78%; P < 0.0001) than did RRP patients. The two groups had similar morphine-equivalent opioid use intraoperatively, but in the PACU, RALP patients required fewer morphine equivalents (mean ± SD; 11.4 ± 7.7 mg vs. 14.9 ± 9.8 mg; P < 0.0001). The RALP patients had longer surgical times (mean ± SD; 296 ± 76 vs.193 ± 69 min; P < 0.0001) but shorter PACU stays (mean ± SD; 113 ± 55 min vs. 143 ± 58 min; P < 0.0001) and shorter hospital stays (mean ± SD; 44 ± 77 hrs vs. 56 ± 26 hrs; P = 0.009). Conclusions: Duration of surgery was greater with RALP, but it was associated with less EBL, fewer transfusions of blood products, and shorter PACU and hospital stays. [Copyright &y& Elsevier]

New technologies are regularly being used for surgical treatment of prostate cancer, however the cost associated is often a secondary issue. We assessed the operative costs incurred by using the daVinci robot assisted prostatectomy (RAP) method compared to pure laparoscopic radical prostatectomy (LRP) and open radical prostatectomy (ORP). We retrospectively analyzed three techniques of radical prostatectomies: ORP, LRP, and RAP ( n = 70, 57, 106, respectively). The mean patient age was 53.6, 57.6, and 60 with a mean preoperative prostate specific antigen (PSA) of 7.2, 8.4, and 6.6, respectively. The mean Gleason score was 6. Operative cost was measured for each patient. Charts were reviewed to assess individual patients postoperative requirements, and hospital length of stay (LOS). Intraoperative data show costs to be higher with the RAP and LRP compared to open surgery. Average total operating room (OR) costs per case were $5410, $3876, and $1870 for RAP, LRP, and open prostatectomy, respectively. However when comparisons are made in the postoperative period with regard to LOS, there is a significant advantage of the RAP and LRP groups over open surgery ( P < 0.05). Intraoperative costs are highest for RAP. Both LRP and RAP are associated with a shorter hospital stay. [ABSTRACT FROM AUTHOR]

Background: Robot-assisted radical prostatectomy (RARP) is a widely used treatment method for patients with clinically localized prostate cancer. Posterior reconstruction of urethrovesical anastomosis (UVA) is one of the techniques that provides early recovery of urinary continence after surgery. Changes in the technique of performing posterior reconstruction of UVA may contribute to further improvement of functional results., Aim: To evaluate the functional results of early removal of the urethral catheter (after 3 days) after RARP using a modified surgical technique of performing posterior reconstruction of UVA compared with the standard catheterization time (7 days after surgery)., Materials and Methods: Patients who underwent RARP were randomly assigned to early catheter removal (3 days after surgery, main group, n=15) and standard catheterization time (7 days after surgery, control group, n=15). RARP was performed using the Da Vinci Si system. The primary end point was the rate of spontaneous voiding after catheter removal. Secondary endpoints were the incidence of urine leakage into the paravesical tissue during retrograde cystography, as well as complications according to the Clavien-Dindo system. The frequency and severity of stress urinary incontinence after catheter removal was assessed using the International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form (ICIQ-UI SF)., Results: There were no significant differences between groups in terms of baseline and perioperative parameters. After removal of the catheter, no acute urinary retention was observed in both groups. Also, there were no cases of urine leakage into the paravesical tissue during retrograde cystography. The ICIQ-UI SF questionnaire showed no significant differences between the groups at 1, 3, 6, and 12 months after surgery., Conclusions: The method of modified posterior reconstruction allows to remove the urethral catheter 3 days after RARP. Early removal of the urethral catheter did not adversely affect the early recovery of urinary continence, the quality of UVA, and did not increase the incidence of acute urinary retention. Further studies with longer follow-up periods are needed.

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Purpose: During pneumoperitoneum (PP) for robot-assisted prostatectomy, a deep neuromuscular block (NMB) is necessary. New relaxometry equipment permits maintenance of profound NMB in order to improve patient safety and surgical conditions., Methods: Twenty adult patients undergoing robot-assisted prostatectomy were included. Under automated quantitative relaxometry with the TOFcuffTM device, rocuronium dosing was adapted with the aim to keep NMB at deep levels. The time fractions with intense block (PTC 0), adequately deep block (PTC 1 to 3) and a not sufficiently deep block (PTC > 3) were quantified., Results: An optimally deep block (PTC 1-3) was achieved during 110 ± 38 min (50 ± 15%). Intense block was found during 60 ± 45 min (27 ± 18%) of total PP time. Values of PTC > 3 lasted 60 ± 45 min (23 ± 17%). Median PTC always remained between 1 and 3. Inadvertent movements during PP were never encountered, and operation conditions as reported by the surgeons were excellent., Conclusion: Our technique of controlled profound NMB by repetitive bolus doses achieved its goal in 77% of PP time. Under automated quantitative relaxometry, an optimized rocuronium dosing strategy should be applied to maintain a high level of safety and adequate operation conditions without risking an unnecessary prolongation of NMB into the post-pneumoperitoneum period., Competing Interests: Conflicts of interest MSu declares to have no conflicts of interests. PB has received travel allowances by Merck Sharp & Dohme and by Acutronic Medical Systems. MS has received travel support from Baxter, Switzerland., (© 2020 Michèle Sunnen et al., published by Sciendo.)

Introduction Nowadays, the expectations for functional prostatectomy outcomes are quite high. Robot-assisted laparoscopic radical prostatectomy (RALRP) has become an increasingly common treatment option for men with localized prostate cancer. In this study, we aimed to present the results of our bilateral nerve-sparing RALRP procedure and to evaluate the effects of the learning curve (LC) on perioperative data, early oncologic, and functional outcomes. Methods The records of 132 RALRP cases performed between January 2016 and March 2019 by a single surgeon experienced in open and laparoscopic radical prostatectomy were evaluated retrospectively. Results of 91 cases with the bilateral nerve-sparing technique were analyzed. The learning curve was determined using the moving average method. LC analysis using the moving average method showed that the LC stabilized between cases 40 and 50. So, patients were divided into two groups: group 1 consisted of the first 45 cases, while group 2 consisted of 46-91 st cases. The groups were compared in terms of surgical, functional, and oncologic outcomes. Results The mean duration of surgery was significantly reduced in the second group (250 vs 235 min, p <0.002). However, there was no statistically significant difference between the groups in terms of hemoglobin decrease, hospitalization and catheterization time, and intraoperative and postoperative complication rates. The rates of pT2 cancers' positive surgical margins (PSMs) were 32.4% and 19.4%, respectively. The recovery rate of continence in all the patients was 90.1% at 12 months. The potency ratios were calculated as 33.8% at 12 months. There was no statistically significant difference between the groups in terms of potency and continence rates at 3 months and 12 months, postoperatively. Conclusion For surgeons experienced in retropubic radical prostatectomy (RRP) and laparoscopic radical prostatectomy (LRP) surgeries, RALRP is a safe and feasible surgical procedure for both oncological and functional outcomes even during the learning curve., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2019, Ucar et al.)

Aim: To compare perioperative complications, inpatient cost and length of stay between robot-assisted radical prostatectomy (RARP) and open radical prostatectomy (ORP) using National Inpatient Sample data from 2010 to 2015., Patients & Methods: A total of 69,009 records with RARP or ORP were analyzed using multivariate logistic regression and generalized linear models., Results: The RARP had superior perioperative outcomes at a higher cost (adjusted mean difference = 2956; 95% CI: $2822-$3090) and shorter length of stay (mean difference = 0.85; 95% CI: 0.81-0.89) compared with ORP. Mean cost of RARP was lowest in urban teaching, private invest-own, high volume and northeast region hospitals and highest for black men., Conclusion: Compared with ORP, RARP had significantly better perioperative outcomes at a higher cost.

Relevance: Erectile dysfunction (ED) associated with radical prostatectomy (RP) affects 25-75% of patients and has a significant negative impact on their quality of life AIM: To analyze the maintenance of erectile function after RP depending on the type of endoscopic access and nerve-sparing., Materials and Methods: This retrospective study comprised 231 patients with localized prostate cancer, who underwent surgery between February 2015 and February 2016. Surgery was performed using one of three approaches: laparoscopic, extraperitoneoscopic or robot-assisted. Nerve-sparing surgery was chosen were based on the Briganti nomogram (low risk of extraprostatic extension), Partins table, and taking into account the patients desire to maintain EF. EF and the quality of life were evaluated using the International Index of Erectile Function (IIEF-5) questionnaire and the QoL (Quality of Life) scale., Results: Nerve-sparing RP was performed in 153 patients. Nerve-sparing RP did not differ significantly from non-nerve sparing RP with regard to operative time (p=0.064) and blood loss (p=0.073). According to the pathomorphological study, the prostatic capsule was intact, and surgical margins were negative in all cases. The incidence of significant ED and complete loss of erectile function was greater in patients after non-nerve sparing RP compared with nerve sparing RP [(5.0 (0-10.0) vs. 6.5 (0.8-19,0) points according to the IIEF-5 scale, p=0.271)]; 96.2% versus 72.2% (p<0.001). Nerve-sparing RP had a statistically significant better effect on the quality of life: 1.63+/-1.16 points against 1.88+/-1.02 points (p=0.035)., Conclusion: The best outcomes were observed in patients undergoing robot-assisted RP. Nerve-sparing RP resulted in a lower rate of ED. This advantage without compromising the completeness of resection allows us to consider nerve-sparing RP as an appropriate and validated modality of preventing erectile dysfunction in properly selected patients.

Introduction: Balloon dissection to create the extraperitoneal space to facilitate laparoscopic procedures is generally a safe step. However, complications can include vascular and visceral injuries. Bladder injury during balloon dilation of extraperitoneal space has previously been described during herniorraphy. This is the first reported case of bladder injury during balloon dilation of the extraperitoneal space during robot-assisted radical prostatectomy., Methods: We report transection of bladder at the prostato-vesical junction, during balloon dilation of extraperitoneal space, in a 66-year-old man undergoing extraperitoneal robot-assisted radical prostatectomy., Results: The patient had an uneventful procedure due to immediate recognition of this intra-operative complication. At 6-month follow-up, he reports complete return of urinary continence and is free from biochemical recurrence from prostate cancer., Discussion: Albeit uncommon, balloon-related complications can occur. Surgeons performing extraperitoneal laparoscopic procedures should be aware of the range of potential complications specifically related to balloon dilation of extraperitoneal space. With experience, these complications can be mitigated., (Copyright © 2015 John Wiley & Sons, Ltd.)