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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

2016; Lippincott Williams & Wilkins; Volume: 197; Issue: 4 Linguagem: Inglês

10.1016/j.juro.2016.08.114

1527-3792

Paolo Umari, Nicola Fossati, Giorgio Gandaglia, Morgan Pokorny, Ruben De Groote, Nicolas Geurts, M. Goossens, Peter Schatterman, Geert De Naeyer, Alexandre Mottrie,

Pelvic floor disorders treatments

No AccessJournal of UrologyAdult Urology1 Apr 2017Robotic 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 Paolo Umari, Nicola Fossati, Giorgio Gandaglia, Morgan Pokorny, Ruben De Groote, Nicolas Geurts, Marijn Goossens, Peter Schatterman, Geert De Naeyer, and Alexandre Mottrie Paolo UmariPaolo Umari University of Trieste, Ospedali riuniti di Trieste, Trieste, Italy Department of Urology, Onze Lieve Vrouwziekenhuis Hospital, Aalst, Belgium , Nicola FossatiNicola Fossati 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 , Giorgio GandagliaGiorgio Gandaglia 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 , Morgan PokornyMorgan Pokorny Department of Urology, Wesley Hospital, Brisbane, Queensland, Australia , Ruben De GrooteRuben De Groote Department of Urology, Onze Lieve Vrouwziekenhuis Hospital, Aalst, Belgium , Nicolas GeurtsNicolas Geurts Department of Urology, Onze Lieve Vrouwziekenhuis Hospital, Aalst, Belgium , Marijn GoossensMarijn Goossens Department of Urology, Onze Lieve Vrouwziekenhuis Hospital, Aalst, Belgium , Peter SchattermanPeter Schatterman Department of Urology, Onze Lieve Vrouwziekenhuis Hospital, Aalst, Belgium , Geert De NaeyerGeert De Naeyer Department of Urology, Onze Lieve Vrouwziekenhuis Hospital, Aalst, Belgium , and Alexandre MottrieAlexandre Mottrie Department of Urology, Onze Lieve Vrouwziekenhuis Hospital, Aalst, Belgium View All Author Informationhttps://doi.org/10.1016/j.juro.2016.08.114AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail 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. 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Volume 197Issue 4April 2017Page: 1108-1114 Advertisement Copyright & Permissions© 2017 by American Urological Association Education and Research, Inc.Keywordsoutcome assessment (health care)roboticssolid-statelasersprostatectomyprostatic hyperplasiaMetricsAuthor Information Paolo Umari University of Trieste, Ospedali riuniti di Trieste, Trieste, Italy Department of Urology, Onze Lieve Vrouwziekenhuis Hospital, Aalst, Belgium More articles by this author Nicola Fossati 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 More articles by this author Giorgio Gandaglia 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 More articles by this author Morgan Pokorny Department of Urology, Wesley Hospital, Brisbane, Queensland, Australia More articles by this author Ruben De Groote Department of Urology, Onze Lieve Vrouwziekenhuis Hospital, Aalst, Belgium More articles by this author Nicolas Geurts Department of Urology, Onze Lieve Vrouwziekenhuis Hospital, Aalst, Belgium More articles by this author Marijn Goossens Department of Urology, Onze Lieve Vrouwziekenhuis Hospital, Aalst, Belgium More articles by this author Peter Schatterman Department of Urology, Onze Lieve Vrouwziekenhuis Hospital, Aalst, Belgium More articles by this author Geert De Naeyer Department of Urology, Onze Lieve Vrouwziekenhuis Hospital, Aalst, Belgium More articles by this author Alexandre Mottrie Department of Urology, Onze Lieve Vrouwziekenhuis Hospital, Aalst, Belgium More articles by this author Expand All Advertisement PDF downloadLoading ...