Impact of Intraoperative Enlarged Median Lobe on Functional Recovery Following Robot-Assisted Radical Prostatectomy:...

The impact of intraoperative enlarged median lobe (EML) on outcomes following robot-assisted radical prostatectomy (RARP) remains underexplored. We aimed to evaluate the functional and oncological outcomes in patients with and without EML undergoing RARP.

We retrospectively reviewed 9710 patients who underwent RARP between 2012 and 2021. Patients were stratified into two groups based on intraoperative identification of EML: Group A (no EML, n = 7985) and Group B (EML, n = 1725). Perioperative, pathological, functional, and oncological outcomes were compared. Kaplan-Meier survival curves and log-rank tests were used to assess biochemical recurrence (BCR) and functional recovery.

Median follow-up was 72 months. Patients in Group B were older (65 vs. 63 years, p < 0.001), had higher PSA (6.20 vs. 5.76 ng/mL, p < 0.001), and lower PSA density (0.09 vs. 0.12 ng/mL/cc, p < 0.001). Group B had more low-risk disease (29.8% vs. 24.1%, p < 0.001) and ISUP Grade Group 1 on biopsy (36.1% vs. 26.7%, p < 0.001). Operative time was longer in Group B (119 vs. 110 min, p < 0.001). Continence outcomes were comparable (p = 0.3). Among patients aged < 55 years with baseline SHIM > 21, potency recovery was high regardless of EML or nerve-sparing status. Group B demonstrated a significantly lower 10-year cumulative BCR rate (p = 0.042).

RARP in patients with EML is associated with favorable oncological outcomes and equivalent continence recovery. Potency recovery is primarily influenced by age and baseline sexual function, rather than EML presence or nerve-sparing.

This study is part of the prostate cancer registry (No. 237998).