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Benign Prostatic Hyperplasia Patient Outcomes in Various Robotic-Assisted Simple Prostatectomy Approaches vs Prostate
David E Hinojosa-Gonzalez1, Gal Saffati1, Jackson Cathey2
1Scott Department of Urology, Baylor College of Medicine, Houston, Texas, USA.
Journal of Endourology
|November 24, 2025
Summary
Robotic-assisted simple prostatectomy (RASP) and transurethral prostate enucleation offer comparable outcomes for large prostates (over 80 g). RASP may improve urinary symptoms but involves longer surgery and hospital stays.
Area of Science:
- Urology
- Minimally Invasive Surgery
- Surgical Outcomes Research
Background:
- Benign prostatic hyperplasia (BPH) is a prevalent condition in aging males.
- For prostates exceeding 80 g, robotic-assisted simple prostatectomy (RASP) and transurethral prostate enucleation are leading surgical options.
- Comparative outcome data between these advanced techniques for large prostates are crucial for clinical decision-making.
Purpose of the Study:
- To systematically compare the efficacy and safety of RASP versus various transurethral prostate enucleation techniques.
- To evaluate key outcomes including urinary function, symptom scores, and perioperative complications.
- To provide evidence-based guidance for managing men with significantly enlarged prostates.
Main Methods:
- A systematic review and Bayesian network meta-analysis were performed on randomized controlled trials and cohort studies.
- Outcomes assessed included urinary flow rate, International Prostate Symptom Score (IPSS), complication rates, blood loss, operative time, hospitalization, and catheterization duration.
- Robotic approaches (single-port and multiport) and enucleation methods (HoLEP, thulium laser, bipolar, GreenLight laser) were analyzed.
Main Results:
- No significant difference in overall complication rates was observed between RASP and enucleation.
- Both RASP and enucleation demonstrated similar improvements in urinary flow rates.
- RASP showed a trend towards greater IPSS reduction, comparable blood loss to enucleation, but longer operative times and catheterization periods.
Conclusions:
- Robotic-assisted simple prostatectomy (RASP) demonstrates comparable efficacy to holmium laser enucleation (HoLEP) for large prostates.
- RASP may offer advantages in symptom score improvement and potentially lower incontinence rates.
- Clinical considerations for RASP include longer operative and hospital stays compared to enucleation techniques.
