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Robot-assisted intrafascial simple prostatectomy: novel technique.

PURPOSE
We describe our initial experience with intrafascial robot-assisted simple prostatectomy (IF-RSP). Potential advantages include reduced blood loss, elimination of the need for postoperative bladder irrigation, and elimination of the risk of residual or future prostate cancer, without interrupting potency or continence.


PATIENTS AND METHODS
From June 2011 to March 2012, 10 patients with symptomatic prostatomegaly on transrectal ultrasonography (TRUS) (mean 81 g) underwent IF-RSP. Three patients had acute urinary retention. Demographic perioperative and outcome data were recorded up to 1 month follow-up.


RESULTS
Average age was 71.7 years (range 60-79 years), estimated blood loss was 375 mL (range 150-900 mL), operative time was 106 minutes (range 60-180 min), hospital stay was 1 day (range 0-3 days), and Foley catheter duration was 8.9 days (range 6-14 days). The drain was removed at a mean 2.8 days (range 0-8 days). Mean prostate volume on preoperative TRUS was 81 cc (range 47-153 cc). Mean specimen weight was 81 g (range 50-150 g). Improvement was noted in the International Prostate Symptom Score (preoperative vs postoperative 18.8 vs 1.7) and peak flow rate (12.4 vs 33.49 mL/min). Sexual Health Inventory for Men score ranged from 12 to 24. All patients were completely continent within 1 month postoperatively, and sexual function was preserved. One patient had urinary tract infection and one patient needed blood transfusion postoperatively.


CONCLUSIONS
IF-RSP appears to be a feasible procedure in large-volume prostatomegaly. The entire prostate tissue is removed without compromising continence and potency. Larger series and longer-term follow-up are needed to evaluate the proper place of this approach.