Efficacy of Less Invasive Alternatives to Open Prostatectomy

Currently, the most effective treatment for benign prostatic hyperplasia (BPH) is open prostatectomy (OP)—an invasive procedure. Minimally invasive options for BPH treatment are desired, which has led to the recent introduction of robotic/laparoscopic simple prostatectomy. In a study presented at the American Urological Association Annual Meeting, researchers evaluated outcomes and safety associated with open simple prostatectomy (OSP), laparoscopic simple prostatectomy (LSP), and robotic simple prostatectomy (RSP).

Between January 2018 and September 2018, a consecutive series of 159 patients with lower urinary tract symptoms and large prostates (> 80cc) underwent LSP (n = 66), OSP (n = 61), or RSP (n = 32) at one of three centers. Mean ages were 70 years in the OSP group, 68 in the LSP group, and 67 in the RSP group. The researchers used the trifecta favorable outcome to assess outcomes: no perioperative complications, postoperative International Prostate Symptom Score (IPSS) < 8, and postoperative maximum urinary flow rate (Q_max) >15 ml/s.

The overall complication rate was highest in the OSP group (10/61, 16%); both the LSP and RSP groups had a 9% complication rate (6/66 and 3/32, respectively). When considering the complications using the modified Clavien-dindo classification, most of them were considered low-grade. The mean IPSS improved significantly from baseline compared with postoperatively in all three groups (OSP, from 18 to 5; LSP, from 20 to 3; and RSP, from 33 to 2). Preoperative and postoperative Q_max also improved among OSP (from 7 ml/s to 20 ml/s), LSP (from 9 ml/s to 24 ml/s), and RSP (from 8 ml/s to 23 ml/s) patients.

Overall, a positive trifecta outcome was achieved by 80% of the OSP group, 77% of the LSP group, and 75% of the RSP group. The researchers stated that the results indicate potential for these treatment options, but called for randomized controlled trials to verify these findings.

Cosimo De Nunzo, Anton Zarraonandia, Giuseppe Simone, et al. Comparison Between Open, Laparoscopic vs Robotic Simple Prostatectomy in a Real-life Settings: Analysis of Trifecta Outcomes