Pacini Matteo, Lambertini Luca, Avesani Giulio, Torres Anguiano Juan R, Morgantini Luca, Martin Alec, Sauer Calvo Ruben, Haberal Hakan B, Bignante Gabriele, Minervini Andrea, Zucchi Alessandro, Bartoletti Riccardo, Crivellaro Simone
Department of Urology, University of Illinois at Chicago, Chicago, IL, USA.
Urology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
Prostate Cancer Prostatic Dis. 2025 Jun;28(2):451-456. doi: 10.1038/s41391-024-00923-y. Epub 2024 Nov 19.
Robot-Assisted Simple Prostatectomy (RASP) is recommended for the treatment of large prostate glands. The introduction of the Single-Port (SP) platform in 2018 has enabled transvesical approach to SP-RASP with promising outcomes. Our aim was to describe the functional and urinary continence outcomes of SP-RASP.
Clinical and surgical data from all consecutive patients who underwent transvesical SP-RASP between February 2020 and March 2024 were collected in a prospectively maintained institutional dataset and retrospectively analyzed. All procedures were performed using the da Vinci SP platform without any conversions to open surgery. Postoperative outcomes were gathered and analyzed, with a particular focus on the incidence of urinary incontinence (UI) and the time to continence recovery.
Overall, 89 patients underwent SP-RASP, with a median prostate size of 110 grams (90-171.5) and a median PSA level of 5.5 mg/dl (2.77-10.93). All patients were on at least one prostate medication prior to surgery. Preoperative evaluations showed a median International Prostate Symptoms Score (IPSS) of 23 (20-27), Quality of Life (QoL) of 4 (3-5), and Post-voiding Residual (PVR) of 153 ml (60-400). The median operative time was 180 min (164-200), with a median estimated blood loss of 100 ml (30-180). Postoperatively, no patients required continuous bladder irrigation. The median postoperative opioid intake was 6.5 morphine equivalents (0-10), with over 78% not requiring narcotics after discharge. Overall, 77.5% were same day discharged. No Clavien-Dindo > 2 complications were recorded. The median follow-up time was 18 (7-35) months. At the last postoperative urological evaluation, the median IPSS was 5 (3-7), QoL was 1 (0-2), and PVR was 10 ml (0-25). Only 4 patients (4.5%) experienced UI postoperatively, and all were continent within 3 months.
The UI incidence rate and functional outcomes of SP-RASP are very encouraging, likely due to precise adenoma and urethra dissection and bladder neck reconstruction. This approach also allows for same-day discharge.
机器人辅助单纯前列腺切除术（RASP）被推荐用于治疗大前列腺腺体。2018年单孔（SP）平台的引入使得经膀胱途径进行SP-RASP成为可能，并取得了令人鼓舞的结果。我们的目的是描述SP-RASP的功能和尿失禁结局。
收集2020年2月至2024年3月期间所有连续接受经膀胱SP-RASP的患者的临床和手术数据，这些数据前瞻性地保存在机构数据集中并进行回顾性分析。所有手术均使用达芬奇SP平台进行，无任何转为开放手术的情况。收集并分析术后结局，特别关注尿失禁（UI）的发生率和控尿恢复时间。
总体而言，89例患者接受了SP-RASP，前列腺中位大小为110克（90 - 171.5），PSA中位水平为5.5毫克/分升（2.77 - 10.93）。所有患者在手术前至少服用一种前列腺药物。术前评估显示国际前列腺症状评分（IPSS）中位值为23（20 - 27），生活质量（QoL）为4（3 - 5），残余尿量（PVR）为153毫升（60 - 400）。中位手术时间为180分钟（164 - 200），中位估计失血量为100毫升（30 - 180）。术后，无患者需要持续膀胱冲洗。术后阿片类药物的中位摄入量为6.5吗啡当量（0 - 10），超过78%的患者出院后不需要使用麻醉剂。总体而言，77.5%的患者在同一天出院。未记录到Clavien-Dindo > 2级并发症。中位随访时间为18（7 - 35）个月。在最后一次术后泌尿外科评估时，IPSS中位值为5（3 - 7），QoL为1（0 - 2），PVR为10毫升（0 - 25）。只有4例患者（4.5%）术后出现UI，且所有患者在3个月内恢复控尿。
SP-RASP的UI发生率和功能结局非常令人鼓舞，这可能归因于精确的腺瘤和尿道解剖以及膀胱颈重建。这种方法还允许患者同一天出院。
