Transvesical versus extraperitoneal single-port robotic radical prostatectomy: a matched-pair analysis

Area of Science:

• Urology
• Minimally Invasive Surgery
• Oncologic Surgery

Background:

• Radical prostatectomy is a standard treatment for localized prostate cancer.
• Single-port (SP) surgical techniques are evolving to minimize invasiveness.
• Transvesical radical prostatectomy (TVRP) and extraperitoneal radical prostatectomy (ERP) are SP approaches with distinct perioperative and functional outcomes.

Purpose of the Study:

• To compare initial perioperative and postoperative outcomes of SP transvesical radical prostatectomy (TVRP) versus SP extraperitoneal radical prostatectomy (ERP).

Main Methods:

• Retrospective analysis of 78 patients undergoing SP TVRP (Dec 2020-Oct 2021) and 169 patients undergoing SP ERP (Feb 2019-Nov 2020).
• Matched-pair analysis based on PSA, Gleason score, and prostate volume.
• Evaluation of preoperative, perioperative, and early functional outcomes, with median follow-up of 7 months (TVRP) and 9 months (ERP).

Main Results:

• SP TVRP had a longer operative time (p=0.002) but fewer grade 3a Clavien-Dindo complications (p=0.026).
• Foley catheter duration was significantly shorter in the TVRP group (3 days vs. 7 days, p<0.001).
• TVRP demonstrated superior continence rates at 6 weeks (72% vs. 48%, p=0.004), 3 months (97% vs. 81%, p=0.008), and 6 months (100% vs. 93%, p=0.047), with no difference in biochemical recurrence.

Conclusions:

• Initial results suggest SP TVRP facilitates faster urinary continence recovery.
• The TVRP approach achieves comparable functional and oncological outcomes to SP ERP.
• SP TVRP represents a promising alternative for selected prostate cancer patients.