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Transvesical robot‐assisted radical prostatectomy: initial experience and surgical outcomes

OBJECTIVES: To describe in detail the techniques for transvesical robot‐assisted radical prostatectomy (RARP) using the da Vinci Si/Xi system (Intuitive Surgical, Sunnyvale, CA, USA) and to evaluate functional and oncological outcomes in 35 patients with prostate cancer. PATIENTS AND METHODS: Thirty...

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Autores principales: Zhou, Xiaochen, Fu, Bin, Zhang, Cheng, Liu, Weipeng, Guo, Ju, Chen, Luyao, Lei, Enjun, Zhang, Xu, Wang, Gongxian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7497005/
https://www.ncbi.nlm.nih.gov/pubmed/32402143
http://dx.doi.org/10.1111/bju.15111
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author Zhou, Xiaochen
Fu, Bin
Zhang, Cheng
Liu, Weipeng
Guo, Ju
Chen, Luyao
Lei, Enjun
Zhang, Xu
Wang, Gongxian
author_facet Zhou, Xiaochen
Fu, Bin
Zhang, Cheng
Liu, Weipeng
Guo, Ju
Chen, Luyao
Lei, Enjun
Zhang, Xu
Wang, Gongxian
author_sort Zhou, Xiaochen
collection PubMed
description OBJECTIVES: To describe in detail the techniques for transvesical robot‐assisted radical prostatectomy (RARP) using the da Vinci Si/Xi system (Intuitive Surgical, Sunnyvale, CA, USA) and to evaluate functional and oncological outcomes in 35 patients with prostate cancer. PATIENTS AND METHODS: Thirty‐five patients with localized prostate cancer were enrolled for transvesical RARP. The patients' preoperative data (mean ± sd age 63.4 ± 8.1 years, body mass index 28.6 ± 5.3 kg/m(2), total prostate‐specific antigen 10.8 ± 4.9 ng/mL and prostate volume 30.6 ± 14.4 mL, and median [interquartile range {IQR}] biopsy Gleason score 6 [6–7], and International Index of Erectile Function [IIEF]‐5 score 18 [16–20]) were collected. Preoperative assessment revealed 28 cases of cT2a and seven cases of cT2b disease. All patients were continent preoperatively (defined as no pad required or one dry pad per day as a precaution). Surgical results and peri‐operative complications were assessed. All patients were followed up for at least 12 months postoperatively. RESULTS: The mean operating time was 150 ± 35 min. Estimated blood loss was 100 ± 45 mL. Urinary infection was noted in one patient and managed with levofloxacin. Another patient complained of nocturia on postoperative day 14, which was relieved with solifenacin succinate. Urethral catheters were removed on postoperative day 7. Thirty‐two patients achieved immediate urinary continence, with three patients returning to full continence on postoperative day 14. Postoperative pathology confirmed 24 pT2a cases, nine pT2b cases and two pT2c cases (median [IQR] Gleason score 6 [6–7]). Positive surgical margins were found in four patients (11.4%). No urethral stricture or urinary leakage was noted on urethrocystography taken 3 months after surgery. Urodynamic studies were performed preoperatively and 6 months after surgery: median (IQR) maximum urinary flow 12.2 (10.2–14.9) vs 13.7 (10.1–15.0) mL/s; bladder capacity 385.3 (351.3–410.2) vs 370.2 (330.1–395.4) mL; and voiding phase detrusor contractility 38.5 (27.8–42.3) vs 35.6 (28.3–41.3) mmH(2)O, respectively. During a minimum of 12 months of follow‐up, no biochemical recurrence was noted in any patient. The median (IQR) IIEF‐5 score was 17 (16–19). CONCLUSIONS: The transvesical approach is a valid alternative to RARP in selected patients, providing promising postoperative urinary continence. Long‐term functional and oncological results require further investigation.
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spelling pubmed-74970052020-09-25 Transvesical robot‐assisted radical prostatectomy: initial experience and surgical outcomes Zhou, Xiaochen Fu, Bin Zhang, Cheng Liu, Weipeng Guo, Ju Chen, Luyao Lei, Enjun Zhang, Xu Wang, Gongxian BJU Int Original Articles OBJECTIVES: To describe in detail the techniques for transvesical robot‐assisted radical prostatectomy (RARP) using the da Vinci Si/Xi system (Intuitive Surgical, Sunnyvale, CA, USA) and to evaluate functional and oncological outcomes in 35 patients with prostate cancer. PATIENTS AND METHODS: Thirty‐five patients with localized prostate cancer were enrolled for transvesical RARP. The patients' preoperative data (mean ± sd age 63.4 ± 8.1 years, body mass index 28.6 ± 5.3 kg/m(2), total prostate‐specific antigen 10.8 ± 4.9 ng/mL and prostate volume 30.6 ± 14.4 mL, and median [interquartile range {IQR}] biopsy Gleason score 6 [6–7], and International Index of Erectile Function [IIEF]‐5 score 18 [16–20]) were collected. Preoperative assessment revealed 28 cases of cT2a and seven cases of cT2b disease. All patients were continent preoperatively (defined as no pad required or one dry pad per day as a precaution). Surgical results and peri‐operative complications were assessed. All patients were followed up for at least 12 months postoperatively. RESULTS: The mean operating time was 150 ± 35 min. Estimated blood loss was 100 ± 45 mL. Urinary infection was noted in one patient and managed with levofloxacin. Another patient complained of nocturia on postoperative day 14, which was relieved with solifenacin succinate. Urethral catheters were removed on postoperative day 7. Thirty‐two patients achieved immediate urinary continence, with three patients returning to full continence on postoperative day 14. Postoperative pathology confirmed 24 pT2a cases, nine pT2b cases and two pT2c cases (median [IQR] Gleason score 6 [6–7]). Positive surgical margins were found in four patients (11.4%). No urethral stricture or urinary leakage was noted on urethrocystography taken 3 months after surgery. Urodynamic studies were performed preoperatively and 6 months after surgery: median (IQR) maximum urinary flow 12.2 (10.2–14.9) vs 13.7 (10.1–15.0) mL/s; bladder capacity 385.3 (351.3–410.2) vs 370.2 (330.1–395.4) mL; and voiding phase detrusor contractility 38.5 (27.8–42.3) vs 35.6 (28.3–41.3) mmH(2)O, respectively. During a minimum of 12 months of follow‐up, no biochemical recurrence was noted in any patient. The median (IQR) IIEF‐5 score was 17 (16–19). CONCLUSIONS: The transvesical approach is a valid alternative to RARP in selected patients, providing promising postoperative urinary continence. Long‐term functional and oncological results require further investigation. John Wiley and Sons Inc. 2020-06-01 2020-08 /pmc/articles/PMC7497005/ /pubmed/32402143 http://dx.doi.org/10.1111/bju.15111 Text en © 2020 The Authors BJU International published by John Wiley & Sons Ltd on behalf of BJU International This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Original Articles
Zhou, Xiaochen
Fu, Bin
Zhang, Cheng
Liu, Weipeng
Guo, Ju
Chen, Luyao
Lei, Enjun
Zhang, Xu
Wang, Gongxian
Transvesical robot‐assisted radical prostatectomy: initial experience and surgical outcomes
title Transvesical robot‐assisted radical prostatectomy: initial experience and surgical outcomes
title_full Transvesical robot‐assisted radical prostatectomy: initial experience and surgical outcomes
title_fullStr Transvesical robot‐assisted radical prostatectomy: initial experience and surgical outcomes
title_full_unstemmed Transvesical robot‐assisted radical prostatectomy: initial experience and surgical outcomes
title_short Transvesical robot‐assisted radical prostatectomy: initial experience and surgical outcomes
title_sort transvesical robot‐assisted radical prostatectomy: initial experience and surgical outcomes
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7497005/
https://www.ncbi.nlm.nih.gov/pubmed/32402143
http://dx.doi.org/10.1111/bju.15111
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