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Minerva Urologica e Nefrologica 2019 Dec 12

DOI: 10.23736/S0393-2249.19.03567-7


lingua: Inglese

Laparoscopic simple prostatectomy: a large single center prospective cohort study

Anton ZARRAONANDIA ANDRACA 1, Riccardo LOMBARDO 2, Almudena CARRION VALENCIA 1, Juan A. GONZÁLEZ-DACAL 1, Higinio R. NÚÑEZ 1, Paula SAMPER MATEO 1, Angela SICA 2, Giorgia TEMA 2 *, Cosimo DE NUNZIO 2, Andrea TUBARO 2, Manuel R. MOLDES 1

1 Complexo Hospitalario Universitario de Pontevedra, Galicia, Spain; 2 Ospedale Sant’Andrea, ‘Sapienza’ Universita di Roma, Rome, Italy


BACKROUND: Aim of our study was to analyse outcomes and safety of laparoscopic simple prostatectomy (LSP) in a high volume center.
METHODS: A consecutive series of men with lower urinary tract symptoms and large prostates (>80cc) prospectively enrolled between November 2015 and December 2017 in one center. All patients underwent laparoscopic simple prostatectomy. Outcomes were evaluated considering the trifecta favourable outcome which was defined as a combination of the following items: (1) no perioperative complications, (2) postoperative IPSS <8, and (3) postoperative Qmax >15 ml/s. Complications were evaluated according to the modified Clavien classification system. Univariate and multivariate binary logistic regression was performed to identify predictors of a positive trifecta outcome.
RESULTS: Overall 272 patients were enrolled. At three months after surgery median IPSS total score was 4 (IQR:3/7), median IPSS Qol was 1 (IQR:1/2), median PSA was 0.53 (IQR:0.33/1.00) ng/ml and median Qmax was 23 (17/30) ml/s. All these parameters improved statistically when compared to baseline (p<0.001). The overall complication rate was 21 % however most of the complications were low grade complications according to modified Clavien Dindo classification (Grade ≤2). Overall, 68% of the patients presented a positive trifecta outcome. On multivariate analysis only preoperative Haemoglobin and hospital stay were confirmed predictors of positive trifecta outcome.
CONCLUSIONS: LSP represents a safe and effective procedure in the treatment of large adenomas. Although RCTs are needed before reaching definitive conclusions, LSP is a promising technique for patients with LUTS and large prostates.

KEY WORDS: Simple prostatectomy; Laparoscopy; Benign prostatic hyperplasia; Lower urinary tract symptoms; Minimally invasive surgery

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