Simple prostatectomy is indicated in patients with enlarged glands (>80 grams) who present with lower urinary tract symptoms (LUTS) attributed to benign prostatic hyperplasia (BPH). Salvage simple prostatectomy (SSP) is defined as simple prostatectomy after failed transurethral procedure. The aim of this study is to evaluate the efficacy of primary robotic simple prostatectomy (PSP) versus SSP in ameliorating LUTS.
We retrospectively reviewed 124 patients who underwent robotic simple prostatectomy (RSP) between 2013 and 2021. Indications for surgery were enlarged prostate, bothersome LUTS, or symptoms refractory to medical management and/or previous prostate surgery. PSP and SSP preoperative, perioperative, and postoperative variables were recorded. The severity of LUTS was assessed using the International Prostate Symptom Score (IPSS). Two-tailed t-tests were performed to compare primary vs. salvage RSP cohorts at a p-value (p) of 0.05.
Of 124 patients who underwent RSP, 98 were primary and 26 were in the salvage setting with 16 patients undergoing prior TURP, 3 status post TUMT, 1 status post TUNA, and 3 status post UroLIFT. Mean length of stay following RSP was 1.87 (days). At mean follow up of approximately 12 months, no patient required re-operation for LUTS. Preoperative IPSS for primary and salvage RSP was 18.56 and 16.25, respectively (p=0.36) and postoperative IPSS for primary and salvage RSP was 5.33 and 8.00, respectively (p=0.38).
Regardless of primary or salvage indication, RSP remains a highly efficient and durable procedure for improvement in LUTS. RSP performed in the salvage setting greatly improved urinary function outcomes in patients after failure of previous transurethral procedures.