Background: Current guidelines recommend simple prostatectomy or endoscopic enucleation of the prostate (EEP) as treatment of choice for bladder prostatic obstruction (BPO) caused by large prostate glands. We aimed to provide a wide-ranging analysis of the currently available evidence, comparing safety and effectiveness of robot-assisted simple prostatectomy (RASP) versus open simple prostatectomy (OSP), laparoscopic simple prostatectomy (LSP), and laser EEP. Methods: A systematic search was performed across MEDLINE, EMBASE, and Web of Science databases for retrospective and prospective studies comparing RASP to OSP or LSP or laser EEP (HoLEP/ThuLEP). Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) recommendations were followed to design the search strategies, selection criteria, and evidence report. A meta-analysis evaluated perioperative safety and effectiveness outcomes. The weighted mean difference and risk ratio were used to compare continuous and dichotomous variables, respectively. Quality was assessed using the Newcastle-Ottawa scale and the Cochrane Collaboration's tool for RCT article assessing risk of bias. Results: 15 studies, including 6659 patients, were selected for meta-analysis: 13 observational studies, 1 non-randomized prospective study, and 1 randomized controlled trial. RASP was associated with statistically significant longer operative time (OT) and lower postoperative complication rate, length of stay (LOS), estimated blood loss (EBL), and transfusion rate (TR) compared to OSP. LSP showed longer LOS and lower postoperative SHIM score, with no difference in OT, EBL, and complications. Compared to laser EEP, RASP presented longer LOS and catheterization time and higher TR. ThuLEP presented shorter OT than RASP. No difference were found in functional outcomes between groups both subjectively (IPSS, QoL) and objectively (Qmax, PVR). Conclusion: RASP has become a size-independent treatment for the management of BPO caused by a large prostate gland. It can duplicate the functional outcomes of OSP while offering a better safety profile. When compared to LSP, the latter still stands as a valid lower-cost option, but it requires solid laparoscopic skill sets and therefore it is unlikely to spread on larger scale. When compared to laser EEP, RASP offers a shorter learning curve, but it still suffers from longer catheterization time and LOS.

Robotic assisted simple prostatectomy versus other treatment modalities for large benign prostatic hyperplasia. a systematic review and meta-analysis of over 6500 cases / Pandolfo, Savio Domenico; Del Giudice, Francesco; Chung, Benjamin I; Manfredi, Celeste; De Sio, Marco; Damiano, Rocco; Cherullo, Edward E; De Nunzio, Cosimo; Cacciamani, Giovanni E; Cindolo, Luca; Porpiglia, Francesco; Mirone, Vincenzo; Imbimbo, Ciro; Autorino, Riccardo; Crocerossa, Fabio. - In: PROSTATE CANCER AND PROSTATIC DISEASES. - ISSN 1365-7852. - (2022), pp. 1-16. [10.1038/s41391-022-00616-4]

Robotic assisted simple prostatectomy versus other treatment modalities for large benign prostatic hyperplasia. a systematic review and meta-analysis of over 6500 cases

Del Giudice, Francesco;De Nunzio, Cosimo;
2022

Abstract

Background: Current guidelines recommend simple prostatectomy or endoscopic enucleation of the prostate (EEP) as treatment of choice for bladder prostatic obstruction (BPO) caused by large prostate glands. We aimed to provide a wide-ranging analysis of the currently available evidence, comparing safety and effectiveness of robot-assisted simple prostatectomy (RASP) versus open simple prostatectomy (OSP), laparoscopic simple prostatectomy (LSP), and laser EEP. Methods: A systematic search was performed across MEDLINE, EMBASE, and Web of Science databases for retrospective and prospective studies comparing RASP to OSP or LSP or laser EEP (HoLEP/ThuLEP). Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) recommendations were followed to design the search strategies, selection criteria, and evidence report. A meta-analysis evaluated perioperative safety and effectiveness outcomes. The weighted mean difference and risk ratio were used to compare continuous and dichotomous variables, respectively. Quality was assessed using the Newcastle-Ottawa scale and the Cochrane Collaboration's tool for RCT article assessing risk of bias. Results: 15 studies, including 6659 patients, were selected for meta-analysis: 13 observational studies, 1 non-randomized prospective study, and 1 randomized controlled trial. RASP was associated with statistically significant longer operative time (OT) and lower postoperative complication rate, length of stay (LOS), estimated blood loss (EBL), and transfusion rate (TR) compared to OSP. LSP showed longer LOS and lower postoperative SHIM score, with no difference in OT, EBL, and complications. Compared to laser EEP, RASP presented longer LOS and catheterization time and higher TR. ThuLEP presented shorter OT than RASP. No difference were found in functional outcomes between groups both subjectively (IPSS, QoL) and objectively (Qmax, PVR). Conclusion: RASP has become a size-independent treatment for the management of BPO caused by a large prostate gland. It can duplicate the functional outcomes of OSP while offering a better safety profile. When compared to LSP, the latter still stands as a valid lower-cost option, but it requires solid laparoscopic skill sets and therefore it is unlikely to spread on larger scale. When compared to laser EEP, RASP offers a shorter learning curve, but it still suffers from longer catheterization time and LOS.
2022
simple prostatectomy; benign prostatic hyperplasia; turp
01 Pubblicazione su rivista::01a Articolo in rivista
Robotic assisted simple prostatectomy versus other treatment modalities for large benign prostatic hyperplasia. a systematic review and meta-analysis of over 6500 cases / Pandolfo, Savio Domenico; Del Giudice, Francesco; Chung, Benjamin I; Manfredi, Celeste; De Sio, Marco; Damiano, Rocco; Cherullo, Edward E; De Nunzio, Cosimo; Cacciamani, Giovanni E; Cindolo, Luca; Porpiglia, Francesco; Mirone, Vincenzo; Imbimbo, Ciro; Autorino, Riccardo; Crocerossa, Fabio. - In: PROSTATE CANCER AND PROSTATIC DISEASES. - ISSN 1365-7852. - (2022), pp. 1-16. [10.1038/s41391-022-00616-4]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1669331
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