Suprapubic transvesical adenoma resection versus robot-assisted simple prostatectomy for prostates ≥ 80 mL: an...

Robot-assisted simple prostatectomy (RASP) is an established but resource-intensive option for large benign prostatic enlargement. Suprapubic transvesical adenoma resection of the prostate (STAR-P) is a recently described bipolar endoscopic technique that resects the adenoma through a suprapubic access, avoiding transurethral instrumentation. We compared their early outcomes in prostates ≥ 80 mL.

In an exploratory, non-randomized, two-centre analysis of prospectively maintained data, we compared baseline, perioperative and one-month outcomes, changes from baseline, and a composite endpoint [Trifecta: maximum urinary flow rate (Qmax) > 15 mL/s, International Prostate Symptom Score (IPSS) < 8, no postoperative complications], with a logistic model adjusting for age and baseline IPSS.

Sixty-one patients were included (26 STAR-P, 35 RASP). STAR-P patients were older (69.5 vs. 64.0 years; p = 0.019), with higher baseline IPSS (29.5 vs. 25.0; p = 0.005) and more often a prominent median lobe (84.6% vs. 48.6%; p = 0.006). Catheterization was shorter after STAR-P (3 vs. 7 days; p < 0.001), whereas postoperative Qmax was higher after RASP (24.0 vs. 13.8 mL/s; p = 0.002). STAR-P showed a greater IPSS reduction and a smaller haemoglobin decrease; ΔQmax did not differ (p = 0.100). No major bleeding event occurred after STAR-P versus nine (26%) after RASP. Trifecta did not differ (42% vs. 54%; p = 0.440), but the study had only 15% power for this comparison.

STAR-P and RASP showed distinct early profiles rather than superiority of either technique: STAR-P favoured shorter catheterization, lower symptoms and less bleeding, whereas RASP produced stronger early flow improvement. Whether avoiding the urethra reduces urethral morbidity remains an untested hypothesis.