Presentation Authors: Andrea Boni*, Morena Turco, Giovanni Cochetti, Paolo Guiggi, Michele Del Zingaro, Emanuele Lepri, Alessio Paladini, Ettore Mearini, Perugia, Italy
Introduction: As Active Surveillance (AS) become more prevalent in the community, more urologists are faced with the challenge of Bladder Outlet obstruction (BOO) in patients (pt) with Low-Risk Prostate Cancer (LR-PCa). Our aim was to evaluate the disobstructive capacity of full-Nerve Sparing Robot Assisted Radical Prostatectomy (fNSRARP) compared to a cohort of pt undergoing Holmium Laser Enucleation of the Prostate (HoLEP).
Methods: On our database of 700 RARP, we retrospectively analyzed 80 pt with LR-PCa with a median Follow Up (FU) of 18 months (range 12-36). We included only pt with cT1c, GS < 6, PSA < 10 ng/ml, potentially eligible to AS according to recent evidences, with a BOO pattern at Uroflowmetry (UF) (Fmax < 15 ml/s) and IPSS (>8). After cognitive fusion biopsy all pt underwent fNSRARP according to PERUSIA technique, with urethral maximization. Pt >70 yr, diabetic, with apical disease, prostate < 50 gr, non sexual activity and with a FU < 12 months were excluded. An age-matched cohort of 20 pt with comparable prostate volume who underwent HoLEP was recruited as a control group. All pt underwent UF, Uroflow Stop Test (UST), IPSS, ICS, IIEF-5 score preoperatively and at 12 months. Complications evaluated according to Clavien Dindo. Urinary Incontinence was assessed through UST at 12 months and direct interview (question number 5 of EPIC questionnaire). Positive UST test, and no pad use identify fully continent pt, the others were considered as incontinent. Potency was achieved when IIEF-5 was >17, with or without oral drug. Student T and Chi-square tests (SPSSÂ®software) were used with a significance level < 0.05.
Results: Table shows our results. Median catheterization time and hospital stay were 7 days (range 6-14) and 2 days (range 1-12); overall complications&[prime] rate was 25% (20) and 10% (2) respectively in the two groups. No major complications occurred. Positive surgical margin rate was 15% (12 pt), with upgrading occurred in 21pt (26,2%). No pt needed Radiotherapy. Pentafecta rate was 65% (48 pt). No statistical differences were detected between the two groups for studied parameters.
Conclusions: Management of obstructed pt during AS is far to be determined and urologists must inform pt before choosing clinical strategy for LR-PCa. Beyond the good pentafecta rate, fNSRARP allows to achieve a BOO resolution at 1 year comparable to pt undergoing HoLEP.