Transvesical Robot Assisted Radical Prostatectomy: Initial Experience and Surgical Outcomes.

OBJECTIVES: To describe the detailed techniques for transvesical robot-assisted radical prostatectomy (TvRARP) using da Vinci Si/Xi system and evaluate the functional and oncological outcomes in 35 prostate cancer patients. PATIENTS AND METHODS: 35 patients with localized prostate cancer were enrolled for TvRARP. Preoperative data of patients [mean ± SD: patient age 63.4 ± 8.1 years, BMI 28.6 ± 5.3 kg/m2 , tPSA 10.8 ± 4.9 ng/ml, prostate volume 30.6 ± 14.4 ml; median (IQR): biopsy Gleason score 6 (6, 7), and IIEF-5 score 18 (16, 20)] were collected. Preoperative assessment revealed 28 case of cT2a and 7 case of cT2b. All patients were continent preoperatively (defined as no pad required or 1 dry pad per day for precaution). Surgical results and perioperative complications were assessed. All patients were followed up for at least 12 months postoperatively. RESULTS: The mean operation time was 150 ± 35 min. Estimated blood loss was 100 ± 45 ml. Urinary infection was noted in 1 patient and managed with levofoxacin. Another patient complained of nocturia on postoperative day 14 and relieved with solifenacin succinate. Urethral catheters were removed on postoperative day 7. 32 patients achieved immediate urinary continence, with 3 patients returning to full continence on postoperative day 14. Postoperative pathology confirmed 24 pT2a cases, 9 pT2b cases and 2 pT2c case [Gleason score 6 (6, 7)]. Positive surgical margin was found in 4 patients (11.4%). No urethral stricture or urinary leakage was noted on urethrocystography taken 3 months after surgery. Urodynamic studies performed preoperatively and 6 months after surgery: maximal urinary flow [pre-op verse 6 months post-op, 12.2 (10.2, 14.9) ml/s vs 13.7 (10.1, 15.0) ml/s], bladder capacity [385.3 (351.3, 410.2) ml vs 370.2 (330.1, 395.4) ml] and voiding phase detrusor contractility [38.5 (27.8, 42.3) mmH2 O vs 35.6 (28.3, 41.3) mmH2 O]. During a minimal of 12-month follow up, no biochemical recurrence was noted in all patients. IIEF-5 score was 17 (16, 19). CONCLUSIONS: The transvesical approach is a valid alternative for RARP in selected patients, providing promising postoperative urinary continence. Long term functional and oncological results requires further investigation.