At one time, an open simple prostatectomy was believed to be the best surgical treatment option for men with a large prostate, or benign prostatic hyperplasia (BPH). However, times are changing, and more advanced options are becoming available. In a new study, investigators looked at robot-assisted versus simple prostatectomy for BPH.
An open simple prostatectomy is usually recommended for men who have severe urinary symptoms that have not responded to other treatment options, and who have a very enlarged prostate gland. Unlike a radical prostatectomy, which is typically performed for men with prostate cancer, a simple prostatectomy does not involve removing the entire prostate. Instead, the only part of the prostate that is removed is the area that is blocking urinary flow.
With the robot-assisted approach, the affected portion of the prostate is removed via a tiny incision below the navel. Before the incision is made, clinicians may perform a cystoscopy, which is when they insert a long, flexible scope through the tip of the penis so they can view the inside of the bladder, urethra, and prostate region. Once the offensive portion of the prostate has been removed, one or two drainage tubes may be inserted near the surgery site to help remove any excess fluid.
In the new review, the authors compared the two approaches and found the following:
- The robotic approach was associated with a shorter hospital stay and lower morbidity but the procedure took longer than did the simple open prostatectomy
- The need for blood transfusions with the simple prostatectomy was three to four times greater than for the robotic approach
- Major complications were twice as likely to occur among men who underwent the simple prostatectomy rather than the robotic approach
- Symptom scores and flow rate were similar in men who underwent either procedure
- Rate of prostate-specific antigen (PSA) decline also was similar between the two groups
The authors concluded that robot-assisted simple prostatectomy is an effective and safe treatment option for men with a large prostate associated with BPH.
In addition, the robot-assisted technique is no longer considered to be an investigational technique by the latest American Urology Association guidelines concerning BPH and is now recommended as an alternative to the open simple prostatectomy for this prostate condition. Men with a large prostate and BPH should discuss this treatment with their physician.
Shah AA et al. Comparison of robot-assisted versus open simple prostatectomy for benign prostatic hyperplasia. Current Urology Reports 2018 Jul 12; 19(9): 71