Sebastian Nestler1, T Bach2, T Herrmann3,4, S Jutzi4, F C Roos5,6, C Hampel5,7, J W Thüroff5, C Thomas5, A Neisius5,8. 1. Department of Urology, University of Mainz, Mainz, Germany. Sebastian-nestler@web.de. 2. Department of Urology, Hospital Harburg, Hamburg, Germany. 3. Department of Urology, Spital Thurgau AG, Frauenfeld, Switzerland. 4. Hannover Medical School (MHH), Hannover, Germany. 5. Department of Urology, University of Mainz, Mainz, Germany. 6. Department of Urology, University of Frankfurt, Frankfurt, Germany. 7. Department of Urology, Marien Hospital, Erwitte, Germany. 8. Department of Urology, Brüderkrankenhaus Trier, University of Mainz, Trier, Germany.
Abstract
OBJECTIVE: To compare open simple prostatectomy, endoscopic enucleation and laparoscopic, robot-assisted enucleation of high-volume prostate in terms of operation time, blood loss, transfusion and complication rates and early continence rates. MATERIAL AND METHODS: Patients with BPH treated endoscopically (ThuVEP, Hamburg and Hannover) or robotically (Mainz) were evaluated prospectively for prostate size, free flow and validated questionnaires (IPSS, QoL). 35 patients were matched to patients after open prostatectomy (Mainz) for age, prostate size, IPSS and QoL scores. Operation time was noted from the first cut to the last suture; blood loss was estimated by the drop of haemoglobin preoperatively and one day after surgery. Transfusion rates were documented. Early continence was estimated by pad use over the first 24 h after catheter removal. Statistical analysis was performed with SPSS 22.0. RESULTS: No significant differences in prostate size, age and preoperative questionnaires were found (p > 0.3). Postoperative flow and the results of the questionnaires were significantly improved (all p < 0.05), without difference between the approaches (p > 0.8). Endoscopic surgery showed superiority in operation time (both p < 0.05); blood loss and transfusion rates were significantly lower compared to open surgery (both p < 0.01) and lower than in robotic surgery without reaching significance (p = 0.18, p = 0.36). Similar results were seen in early continence rates. CONCLUSION: Due to our results, endoscopic surgery should be considered as first-line therapy unless there are comorbidities like diverticula and/or bladder calculi that can be easily treated simultaneously by robotic surgery. Against the background of these findings, indications favouring open surgery are getting sparse.
OBJECTIVE: To compare open simple prostatectomy, endoscopic enucleation and laparoscopic, robot-assisted enucleation of high-volume prostate in terms of operation time, blood loss, transfusion and complication rates and early continence rates. MATERIAL AND METHODS:Patients with BPH treated endoscopically (ThuVEP, Hamburg and Hannover) or robotically (Mainz) were evaluated prospectively for prostate size, free flow and validated questionnaires (IPSS, QoL). 35 patients were matched to patients after open prostatectomy (Mainz) for age, prostate size, IPSS and QoL scores. Operation time was noted from the first cut to the last suture; blood loss was estimated by the drop of haemoglobin preoperatively and one day after surgery. Transfusion rates were documented. Early continence was estimated by pad use over the first 24 h after catheter removal. Statistical analysis was performed with SPSS 22.0. RESULTS: No significant differences in prostate size, age and preoperative questionnaires were found (p > 0.3). Postoperative flow and the results of the questionnaires were significantly improved (all p < 0.05), without difference between the approaches (p > 0.8). Endoscopic surgery showed superiority in operation time (both p < 0.05); blood loss and transfusion rates were significantly lower compared to open surgery (both p < 0.01) and lower than in robotic surgery without reaching significance (p = 0.18, p = 0.36). Similar results were seen in early continence rates. CONCLUSION: Due to our results, endoscopic surgery should be considered as first-line therapy unless there are comorbidities like diverticula and/or bladder calculi that can be easily treated simultaneously by robotic surgery. Against the background of these findings, indications favouring open surgery are getting sparse.
Authors: Stephan Madersbacher; Jakob Lackner; Clemens Brössner; Michaela Röhlich; Igor Stancik; Manfred Willinger; Georg Schatzl Journal: Eur Urol Date: 2005-01-23 Impact factor: 20.096
Authors: Hemendra N Shah; Amol P Mahajan; Hiren S Sodha; Sunil Hegde; Pradnya D Mohile; Manish B Bansal Journal: J Urol Date: 2007-04 Impact factor: 7.450
Authors: Christian Gratzke; Boris Schlenker; Michael Seitz; Alexander Karl; Peter Hermanek; Nicholas Lack; Christian G Stief; Oliver Reich Journal: J Urol Date: 2007-04 Impact factor: 7.450
Authors: Richard Naspro; Nazareno Suardi; Andrea Salonia; Vincenzo Scattoni; Giorgio Guazzoni; Renzo Colombo; Andrea Cestari; Alberto Briganti; Bruno Mazzoccoli; Patrizio Rigatti; Francesco Montorsi Journal: Eur Urol Date: 2006-05-02 Impact factor: 20.096
Authors: David-Dan Nguyen; Vincent Misraï; Thorsten Bach; Naeem Bhojani; James E Lingeman; Dean S Elterman; Kevin C Zorn Journal: World J Urol Date: 2020-03-02 Impact factor: 4.226
Authors: Simone Scarcella; Daniele Castellani; Vineet Gauhar; Jeremy Yuen-Chun Teoh; Carlo Giulioni; Pietro Piazza; Carlo Andrea Bravi; Ruben De Groote; Geert De Naeyer; Stefano Puliatti; Andrea Benedetto Galosi; Alexandre Mottrie Journal: Investig Clin Urol Date: 2021-11