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Robotic Assisted Simple Prostatectomy versus Holmium Laser Enucleation of the Prostate for Lower Urinary Tract Symptoms in Patients with Large Volume Prostate: A Comparative Analysis from a High Volume Center.
J Urol. 2017 04; 197(4):1108-1114.JU

Abstract

PURPOSE

We report a comparative analysis of robotic assisted simple prostatectomy vs holmium laser enucleation of the prostate in patients who had benign prostatic hyperplasia with a large volume prostate (greater than 100 ml).

MATERIALS AND METHODS

A total of 81 patients underwent robotic assisted simple prostatectomy and 45 underwent holmium laser enucleation of the prostate in a 7-year period. Patients were preoperatively assessed with transrectal ultrasound and uroflowmetry. Functional parameters were assessed postoperatively during followup. Perioperative outcomes included operative time, postoperative hemoglobin, catheterization time and hospitalization. Complications were reported according to the Clavien-Dindo classification.

RESULTS

Compared to the holmium laser enucleation group, patients treated with prostatectomy were significantly younger (median age 69 vs 74 years, p = 0.032) and less healthy (Charlson comorbidity index 2 or greater in 62% vs 29%, p = 0.0003), and had a lower rate of suprapubic catheterization (23% vs 42%, p = 0.028) and a higher preoperative I-PSS (International Prostate Symptom Score) (25 vs 21, p = 0.049). Both groups showed an improvement in the maximum flow rate (15 vs 11 ml per second, p = 0.7), and a significant reduction in post-void residual urine (-73 vs -100 ml, p = 0.4) and I-PSS (-20 vs -18, p = 0.8). Median operative time (105 vs 105 minutes, p = 0.9) and postoperative hemoglobin (13.2 vs 13.8 gm/dl, p = 0.08) were similar for robotic assisted prostatectomy and holmium laser enucleation, respectively. Median catheterization time (3 vs 2 days, p = 0.005) and median hospitalization (4 vs 2 days, p = 0.0001) were slightly shorter in the holmium laser group. Complication rates were similar with no Clavien grade greater than 3 in either group.

CONCLUSIONS

Our results from a single center suggest comparable outcomes for robotic assisted simple prostatectomy and holmium laser enucleation of the prostate in patients with a large volume prostate. These findings require external validation at other high volume centers.

Authors+Show Affiliations

University of Trieste, Ospedali riuniti di Trieste, Trieste, Italy; Department of Urology, Onze Lieve Vrouwziekenhuis Hospital, Aalst, Belgium. Electronic address: paoloumari@alice.it.Division of Oncology, Unit of Urology, Urological Research Institute, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele, Milan, Italy; Department of Urology, Onze Lieve Vrouwziekenhuis Hospital, Aalst, Belgium.Division of Oncology, Unit of Urology, Urological Research Institute, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele, Milan, Italy; Department of Urology, Onze Lieve Vrouwziekenhuis Hospital, Aalst, Belgium.Department of Urology, Wesley Hospital, Brisbane, Queensland, Australia.Department of Urology, Onze Lieve Vrouwziekenhuis Hospital, Aalst, Belgium.Department of Urology, Onze Lieve Vrouwziekenhuis Hospital, Aalst, Belgium.Department of Urology, Onze Lieve Vrouwziekenhuis Hospital, Aalst, Belgium.Department of Urology, Onze Lieve Vrouwziekenhuis Hospital, Aalst, Belgium.Department of Urology, Onze Lieve Vrouwziekenhuis Hospital, Aalst, Belgium.Department of Urology, Onze Lieve Vrouwziekenhuis Hospital, Aalst, Belgium.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

27615435

Citation

Umari, Paolo, et al. "Robotic Assisted Simple Prostatectomy Versus Holmium Laser Enucleation of the Prostate for Lower Urinary Tract Symptoms in Patients With Large Volume Prostate: a Comparative Analysis From a High Volume Center." The Journal of Urology, vol. 197, no. 4, 2017, pp. 1108-1114.
Umari P, Fossati N, Gandaglia G, et al. Robotic Assisted Simple Prostatectomy versus Holmium Laser Enucleation of the Prostate for Lower Urinary Tract Symptoms in Patients with Large Volume Prostate: A Comparative Analysis from a High Volume Center. J Urol. 2017;197(4):1108-1114.
Umari, P., Fossati, N., Gandaglia, G., Pokorny, M., De Groote, R., Geurts, N., Goossens, M., Schatterman, P., De Naeyer, G., & Mottrie, A. (2017). Robotic Assisted Simple Prostatectomy versus Holmium Laser Enucleation of the Prostate for Lower Urinary Tract Symptoms in Patients with Large Volume Prostate: A Comparative Analysis from a High Volume Center. The Journal of Urology, 197(4), 1108-1114. https://doi.org/10.1016/j.juro.2016.08.114
Umari P, et al. Robotic Assisted Simple Prostatectomy Versus Holmium Laser Enucleation of the Prostate for Lower Urinary Tract Symptoms in Patients With Large Volume Prostate: a Comparative Analysis From a High Volume Center. J Urol. 2017;197(4):1108-1114. PubMed PMID: 27615435.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Robotic Assisted Simple Prostatectomy versus Holmium Laser Enucleation of the Prostate for Lower Urinary Tract Symptoms in Patients with Large Volume Prostate: A Comparative Analysis from a High Volume Center. AU - Umari,Paolo, AU - Fossati,Nicola, AU - Gandaglia,Giorgio, AU - Pokorny,Morgan, AU - De Groote,Ruben, AU - Geurts,Nicolas, AU - Goossens,Marijn, AU - Schatterman,Peter, AU - De Naeyer,Geert, AU - Mottrie,Alexandre, Y1 - 2016/09/08/ PY - 2016/08/31/accepted PY - 2016/9/13/pubmed PY - 2019/3/12/medline PY - 2016/9/13/entrez KW - lasers KW - outcome assessment (health care) KW - prostatectomy KW - prostatic hyperplasia KW - robotics KW - solid-state SP - 1108 EP - 1114 JF - The Journal of urology JO - J. Urol. VL - 197 IS - 4 N2 - PURPOSE: We report a comparative analysis of robotic assisted simple prostatectomy vs holmium laser enucleation of the prostate in patients who had benign prostatic hyperplasia with a large volume prostate (greater than 100 ml). MATERIALS AND METHODS: A total of 81 patients underwent robotic assisted simple prostatectomy and 45 underwent holmium laser enucleation of the prostate in a 7-year period. Patients were preoperatively assessed with transrectal ultrasound and uroflowmetry. Functional parameters were assessed postoperatively during followup. Perioperative outcomes included operative time, postoperative hemoglobin, catheterization time and hospitalization. Complications were reported according to the Clavien-Dindo classification. RESULTS: Compared to the holmium laser enucleation group, patients treated with prostatectomy were significantly younger (median age 69 vs 74 years, p = 0.032) and less healthy (Charlson comorbidity index 2 or greater in 62% vs 29%, p = 0.0003), and had a lower rate of suprapubic catheterization (23% vs 42%, p = 0.028) and a higher preoperative I-PSS (International Prostate Symptom Score) (25 vs 21, p = 0.049). Both groups showed an improvement in the maximum flow rate (15 vs 11 ml per second, p = 0.7), and a significant reduction in post-void residual urine (-73 vs -100 ml, p = 0.4) and I-PSS (-20 vs -18, p = 0.8). Median operative time (105 vs 105 minutes, p = 0.9) and postoperative hemoglobin (13.2 vs 13.8 gm/dl, p = 0.08) were similar for robotic assisted prostatectomy and holmium laser enucleation, respectively. Median catheterization time (3 vs 2 days, p = 0.005) and median hospitalization (4 vs 2 days, p = 0.0001) were slightly shorter in the holmium laser group. Complication rates were similar with no Clavien grade greater than 3 in either group. CONCLUSIONS: Our results from a single center suggest comparable outcomes for robotic assisted simple prostatectomy and holmium laser enucleation of the prostate in patients with a large volume prostate. These findings require external validation at other high volume centers. SN - 1527-3792 UR - https://www.unboundmedicine.com/medline/citation/27615435/Robotic_Assisted_Simple_Prostatectomy_versus_Holmium_Laser_Enucleation_of_the_Prostate_for_Lower_Urinary_Tract_Symptoms_in_Patients_with_Large_Volume_Prostate:_A_Comparative_Analysis_from_a_High_Volume_Center_ L2 - https://www.jurology.com/doi/full/10.1016/j.juro.2016.08.114?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -