The impact of prostate size, median lobe, and prior benign prostatic hyperplasia intervention on robot-assisted laparoscopic prostatectomy: Technique and outcomes

Andy C. Huang, Keith J. Kowalczyk, Nathanael D. Hevelone, Stuart R. Lipsitz, Hua Yin Yu, Blakely A. Plaster, Channa A. Amarasekara, William D. Ulmer, Yin Lei, Stephen B. Williams, Jim C. Hu

Research output: Contribution to journalArticle

41 Scopus citations

Abstract

Background: Large prostate size, median lobes, and prior benign prostatic hyperplasia (BPH) surgery may pose technical challenges during robot-assisted laparoscopic prostatectomy (RALP). Objective: To describe technical modifications to overcome BPH sequelae and associated outcomes. Design, settings, and participants: A retrospective study of prospective data on 951 RALP procedures performed from September 2005 to November 2010 was conducted. Outcomes were analyzed by prostate weight, prior BPH surgical intervention (n = 59), and median lobes >1 cm (n = 42). Surgical procedure: RALP. Measurements: Estimated blood loss (EBL), blood transfusions, operative time, positive surgical margin (PSM), and urinary and sexual function were measured. Results and limitations: In unadjusted analysis, men with larger prostates and median lobes experienced higher EBL (213.5 vs 176.5 ml; p < 0.001 and 236.4 vs 193.3 ml; p = 0.002), and larger prostates were associated with more transfusions (4 vs 1; p = 0.037). Operative times were longer for men with larger prostates (164.2 vs 149.1 min; p = 0.002), median lobes (185.8 vs 155.0 min; p = 0.004), and prior BPH surgical interventions (170.2 vs 155.4 min; p = 0.004). Men with prior BPH interventions experienced more prostate base PSM (5.1% vs 1.2%; p = 0.018) but similar overall PSM. In adjusted analyses, the presence of median lobes increased both EBL (p = 0.006) and operative times (p < 0.001), while prior BPH interventions also prolonged operative times (p = 0.014). However, prostate size did not affect EBL, PSM, or recovery of urinary or sexual function. Conclusions: Although BPH characteristics prolonged RALP procedure times and increased EBL, prostate size did not affect PSM or urinary and sexual function.

Original languageEnglish (US)
Pages (from-to)595-603
Number of pages9
JournalEuropean Urology
Volume59
Issue number4
DOIs
StatePublished - Apr 2011
Externally publishedYes

Keywords

  • Benign prostatic hyperplasia
  • Outcomes
  • Prostate cancer
  • Radical prostatectomy
  • Robot-assisted surgery

ASJC Scopus subject areas

  • Urology

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    Huang, A. C., Kowalczyk, K. J., Hevelone, N. D., Lipsitz, S. R., Yu, H. Y., Plaster, B. A., Amarasekara, C. A., Ulmer, W. D., Lei, Y., Williams, S. B., & Hu, J. C. (2011). The impact of prostate size, median lobe, and prior benign prostatic hyperplasia intervention on robot-assisted laparoscopic prostatectomy: Technique and outcomes. European Urology, 59(4), 595-603. https://doi.org/10.1016/j.eururo.2011.01.033