Stefano Tappero1,2,3, Paolo Dell'Oglio4,5,6, Mattia Longoni4, Carlo Buratto4, Erika Palagonia4,7, Pietro Scilipoti4, Enrico Vecchio4,8,9, Marco Martiriggiano4,8,9, Silvia Secco4, Alberto Olivero4, Michele Barbieri4, Giancarlo Napoli4, Elena Strada4, Giovanni Petralia4, Dario Di Trapani4, Aldo Massimo Bocciardi4, Antonio Galfano4. 1. Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy. stefano.m.tappero@gmail.com. 2. Department of Urology, IRCCS Ospedale Policlinico San Martino, University of Genova, Genova, Italy. stefano.m.tappero@gmail.com. 3. Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy. stefano.m.tappero@gmail.com. 4. Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy. 5. Department of Urology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands. 6. Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. 7. Division of Urology, School of Medicine, Department of Clinical, Special and Dental Sciences, University Hospital "Ospedali Riuniti", Marche Polytechnic University, Ancona, Italy. 8. Department of Urology, IRCCS Ospedale Policlinico San Martino, University of Genova, Genova, Italy. 9. Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy.
Abstract
OBJECTIVE: To evaluate the relationship between enlarged prostate, bulky median lobe (BML) or prior benign prostatic hyperplasia (BPH) surgery and perioperative functional, and oncological outcomes in high-risk (HR) prostate cancer (PCa) patients treated with Retzius-sparing robot-assisted radical prostatectomy (RS-RARP). METHODS: 320 HR-PCa patients treated with RS-RARP between 2011 and 2020 at a single high-volume center. The relationship between prostate volume, BML, prior BPH surgery and perioperative outcomes, Clavien-Dindo (CD) grade ≥ 2 90-day postoperative complications, positive surgical margins (PSMs), and urinary continence (UC) recovery was evaluated respectively in multivariable linear, logistic and Cox regression models. Complications were collected according to the standardized methodology proposed by EAU guidelines. UC recovery was defined as the use of zero or one safety pad. RESULTS: Overall, 5.9% and 5.6% had respectively a BML or prior BPH surgery. Median PV was 45 g (range: 14-300). The rate of focal and non-focal PSMs was 8.4% and 17.8%. 53% and 10.9% patients had immediate UC recovery and CD ≥ 2. The 1- and 2-yr UC recovery was 84 and 85%. PV (p = 0.03) and prior BPH surgery (p = 0.02) was associated with longer operative time. BML was independent predictor of time to bladder catheter removal (p = 0.001). PV was independent predictor of PSMs (OR: 1.02; p = 0.009). Prior BPH surgery was associated with lower UC recovery (HR: 0.5; p = 0.03). CONCLUSION: HR-PCa patients with enlarged prostate have higher risk of PSMs, while patients with prior BPH surgery have suboptimal UC recovery. These findings should help physicians for accurate preoperative counseling and to improve surgical planning in case of HR-PCa patients with challenging features.
OBJECTIVE: To evaluate the relationship between enlarged prostate, bulky median lobe (BML) or prior benign prostatic hyperplasia (BPH) surgery and perioperative functional, and oncological outcomes in high-risk (HR) prostate cancer (PCa) patients treated with Retzius-sparing robot-assisted radical prostatectomy (RS-RARP). METHODS: 320 HR-PCa patients treated with RS-RARP between 2011 and 2020 at a single high-volume center. The relationship between prostate volume, BML, prior BPH surgery and perioperative outcomes, Clavien-Dindo (CD) grade ≥ 2 90-day postoperative complications, positive surgical margins (PSMs), and urinary continence (UC) recovery was evaluated respectively in multivariable linear, logistic and Cox regression models. Complications were collected according to the standardized methodology proposed by EAU guidelines. UC recovery was defined as the use of zero or one safety pad. RESULTS: Overall, 5.9% and 5.6% had respectively a BML or prior BPH surgery. Median PV was 45 g (range: 14-300). The rate of focal and non-focal PSMs was 8.4% and 17.8%. 53% and 10.9% patients had immediate UC recovery and CD ≥ 2. The 1- and 2-yr UC recovery was 84 and 85%. PV (p = 0.03) and prior BPH surgery (p = 0.02) was associated with longer operative time. BML was independent predictor of time to bladder catheter removal (p = 0.001). PV was independent predictor of PSMs (OR: 1.02; p = 0.009). Prior BPH surgery was associated with lower UC recovery (HR: 0.5; p = 0.03). CONCLUSION: HR-PCa patients with enlarged prostate have higher risk of PSMs, while patients with prior BPH surgery have suboptimal UC recovery. These findings should help physicians for accurate preoperative counseling and to improve surgical planning in case of HR-PCa patients with challenging features.
Authors: Peter-Paul M Willemse; Niall F Davis; Nikolaos Grivas; Fabio Zattoni; Michael Lardas; Erik Briers; Marcus G Cumberbatch; Maria De Santis; Paolo Dell'Oglio; James F Donaldson; Nicola Fossati; Giorgio Gandaglia; Silke Gillessen; Jeremy P Grummet; Ann M Henry; Matthew Liew; Steven MacLennan; Malcolm D Mason; Lisa Moris; Karin Plass; Shane O'Hanlon; Muhammad Imran Omar; Daniela E Oprea-Lager; Karl H Pang; Catherine C Paterson; Guillaume Ploussard; Olivier Rouvière; Ivo G Schoots; Derya Tilki; Roderick C N van den Bergh; Thomas Van den Broeck; Theodorus H van der Kwast; Henk G van der Poel; Thomas Wiegel; Cathy Yuhong Yuan; Philip Cornford; Nicolas Mottet; Thomas B L Lam Journal: Eur Urol Date: 2021-12-31 Impact factor: 20.096
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Authors: Paolo Dell'Oglio; Stefano Tappero; Mattia Longoni; Carlo Buratto; Pietro Scilipoti; Silvia Secco; Alberto Olivero; Michele Barbieri; Erika Palagonia; Giancarlo Napoli; Elena Strada; Giovanni Petralia; Dario Di Trapani; Angelo Vanzulli; Aldo Massimo Bocciardi; Antonio Galfano Journal: Eur Urol Open Sci Date: 2022-03-04