Search Results (52)

Background/Objectives: Functional continence and potency outcomes are paramount for the pentafecta of robotic-assisted laparoscopic radical prostatectomy (RARP). We describe a modified approach of the pubovesical complex (PVC)-sparing technique under hypothermia for better continence and potency preservation. Methods: This is a retrospective single-institution case series. Thirty-three PVC-sparing RARP procedures under hypothermia were performed in patients with clinically localized prostate cancer by the same experienced surgeon. The method includes four principles: (1) modified PVC-sparing technique, according to Richard Gaston et al., (2) the use of near-infrared fluorescence technology and indocyanine green to identify the benchmark artery of the neurovascular bundle and blood supply for the PVC, (3) accessory pudendal artery preservation, and (4) hypothermia to reduce tissue edema. Functional outcomes, including continence, potency, and other surgical findings, are presented. This is a feasibility case series, not a comparative or hypothesis-testing study. Results: This study enrolled 33 cases from 15 April 2020 to 31 December 2022. Four patients had positive surgical margins. The urinary continence rate was 100% after Foley removal at a mean of 6.6 days. The potency rate was 74% (17/23) at 6 months and 91.3% (21/23) at 12 months. The inclusion of a small sample of patients from a single hospital and the selection of patient conditions were the study limitations. Conclusions: The modified approach we described is technically feasible, and it can expedite the restoration of urinary function and potency preservation. No severe complications occurred, and patients achieved good oncological outcomes. Full article

Introduction: Surgical management of prostate cancer has evolved significantly over more than a century, transitioning from open procedures to modern robot-assisted techniques. This narrative review traces the historical progression of surgical treatments for localized prostate cancer, from early approaches to the most recent advancements. Materials and Methods: An extensive literature search was conducted from 1 April to 1 June 2025, using PubMed and cross-referencing citations. The search gathered studies on the evolution of prostate cancer surgery, technical aspects, and comparisons between surgical and non-surgical treatments. Keywords included “PROSTATE CANCER”, “PROSTATE CANCER SURGICAL TREATMENT”, “RADICAL PROSTATECTOMY EVOLUTION”, “ROBOT-ASSISTED RADICAL PROSTATECTOMY”, and “FOCAL THERAPY AND PROSTATE CANCER”. Results: A total of 65 manuscripts, including original articles, systematic reviews, meta-analyses, and clinical trials focusing on the surgical treatment of localized prostate cancer, were selected. The review begins with the history of prostatic surgery, chronicling its evolution through laparoscopic and, ultimately, robotic approaches. It highlights how improved visualization and new technologies have led to better functional outcomes and preservation of structures while maintaining oncological safety. A specific focus is placed on the technical evolution of robot-assisted radical prostatectomy, new robotic platforms, and the role of focal therapy as an ultra-minimally invasive technique for localized disease. Conclusions: Robot-assisted radical prostatectomy represents the current reference surgical technique for localized prostate cancer. However, it is crucial to acknowledge RALP’s elevated cost and the need for further long-term, randomized data to establish definitive oncological equivalence compared to non-surgical options. Full article

Background/Objectives: Urinary incontinence (UI) remains a common and distressing complication following radical prostatectomy (RP). This prospective observational study aimed to assess the effectiveness of structured pelvic floor rehabilitation and to identify clinical and surgical predictors of continence recovery. Methods: A total of 182 patients undergoing RP received standardized physiotherapist-guided pelvic floor muscle training (PFMT), including supervised sessions before and after surgery, as well as individualized home exercise programs. UI severity was evaluated using a 1 h pad test and a four-level UI stage classification at three time points. The primary outcomes were changes in UI stage and the achievement of full continence, defined as a pad test result ≤2 g. Results: Following three rehabilitation sessions, 80.2% of patients regained full continence. Preoperative PFMT (β = −1.27, p = 0.0061) and shorter time to rehabilitation (β = −0.04, p = 0.0026) were associated with greater improvement in continence outcomes. Patients treated with robot-assisted RP showed a higher probability of continence recovery compared to those undergoing laparoscopic RP, particularly in the presence of moderate to severe baseline incontinence. Higher baseline urinary leakage significantly decreased the odds of treatment success (β = −0.01, p = 0.0001). ISUP grade and extraprostatic extension were not independently associated with outcomes. Conclusions: Despite the absence of a control group, this study demonstrates the effectiveness of structured and personalized pelvic floor rehabilitation in improving post-RP continence. Early initiation and preoperative training should be prioritized to optimize recovery in routine clinical practice. Full article

Robotic-assisted radical prostatectomy (RARP) has emerged as a leading surgical approach for localized prostate cancer in many centers worldwide. Leveraging minimally invasive techniques and advanced visualization, RARP has demonstrated benefits in perioperative and functional outcomes, and at least comparable, if not better, oncologic control relative to open radical prostatectomy (ORP) and laparoscopic radical prostatectomy (LRP). This review summarizes the current evidence on the efficacy, safety, and functional outcomes associated with RARP and discusses its role in contemporary prostate cancer management. Full article

Since its development in 1904, radical prostatectomy (RP) has remained a fundamental surgical option in the management of localised prostate cancer. Over time, continuous advancements in surgical techniques have improved oncological outcomes while reducing functional complications. This narrative review explores the evolution of RP, depicting its progression from the traditional open approach to minimally invasive laparoscopic and robotic-assisted techniques. Key developments in RP techniques, including nerve-sparing, bladder neck-sparing and Retzius-sparing techniques as well as enhanced perioperative management, have contributed to reduced postoperative complications, namely incontinence and erectile dysfunction. Additionally, technological innovations such as augmented reality, utilising indocyanine green for improved visualisation of prostatic boundaries and illuminare-1 to easily identify nerves intraoperatively, artificial intelligence, and novel molecular imaging technologies such as PSMA PETs for improved margin assessment are shaping the future of RPs. Despite these advancements, challenges persist, including a steep learning curve associated with newer techniques, disparities in access due to cost considerations, and a lack of standardised outcome measures across different surgical approaches. This review provides insight into current trends, ongoing challenges, and future directions that may further refine surgical precision, enhance patient safety, and improve long-term treatment success in prostate cancer management. Full article

Background/Objectives: Radical prostatectomy is a standard treatment for localized prostate cancer. We aimed to compare perioperative outcomes and functional results between laparoscopic radical prostatectomy (LRP) and robot-assisted radical prostatectomy (RARP). Methods: A retrospective analysis was conducted on 120 patients who underwent LRP (n = 60) or RARP (n = 60). Perioperative parameters, including operative time, hospitalization duration, blood transfusion rate, wound healing complications, urinary catheterization duration, urinary tract infections (UTIs), and urinary incontinence, were assessed. Statistical analyses included Student’s t-, Mann–Whitney U, and χ² tests. Results: RARP was associated with significantly shorter operative time, compared with LRP (147.25 vs. 188.30 min, p < 0.0001). No significant differences were observed in hospitalization duration, transfusion rates, or overall complication rates. However, impaired wound healing was less frequent in the RARP group, with a 10% lower incidence, compared with the LRP group (p = 0.0946). Similarly, UTIs occurred less often in the RARP group (six vs. one cases; p = 0.0544). Urinary incontinence was significantly less frequent following RARP, with its incidence being more than twice as low, compared with the LRP group (p = 0.0032). Additionally, the RARP group had significantly lower International Prostate Symptom Scores, with a mean difference of 7.83 points, indicating improved urinary function. No significant differences were found in sexual function (IIEF-5 scores). Conclusions: RARP offers advantages over LRP, including reduced operative time, lower rates of wound healing complications, decreased incidence of urinary incontinence, and improved postoperative urinary function. Further studies with larger cohorts are warranted to confirm these findings and assess long-term functional and oncological outcomes. Full article

Objectives: We attempt to assess whether prostate-specific antigen decline rate in the first month (PSADR1M = postoperative PSA in the first month/initial PSA) acts as a predictor for biochemical recurrence (BCR) and to evaluate other preoperative and postoperative variables that may predict BCR following robot-assisted laparoscopic prostatectomy (RARP). Method: Based on the D’Amico risk classification system, 777 patients who underwent RARP for localized prostate cancer were classified into a low/intermediate-risk group (n = 435) and a high-risk group (n = 342). The predictors of BCR were identified by univariate and multivariate logistic regression analyses. The area under the curve (AUC) and optimal cutoff values of PSADR1M were determined by receiver operating characteristic (ROC) analysis. Kaplan–Meier curves for biochemical recurrence-free survival (BRFS) rates were stratified by optimal cutoff values of PSADR1M. Results: Effective predictors of BCR in the entire cohort included pT3 (p < 0.001), pathological Grade Group (pGG3, pGG4+5) compared to pGG1+2 (p < 0.001, p = 0.017), positive surgical margins (PSM) (p < 0.001), seminal vesicle invasion (SVI) (p = 0.006), and PSADR1M ≥ 0.62% (p < 0.001). ROC analysis showed that PSADR1M as a predictor for BCR had an AUC of 0.762 for the whole cohort, and 0.821 for the high-risk group, respectively. The optimal cutoff values of PSADR1M were 0.62% in the whole cohort, and 0.68% in high-risk group. Conclusions: As an effective predictor of BCR, PSADR1M can assess the tumor status of prostate cancer patients intuitively and effectively after RARP, especially in the high-risk group. Full article

Introduction: Laparoscopic and robotic bladder diverticulectomy is a successful option to correct bladder diverticula (BD). Nevertheless, the identification of BD could be a tricky step, due to the presence of pneumoperitoneum compressing the bladder. This occurrence could be particularly evident for the posterior or postero-lateral location of BDs. We present a novel technique to overcome this concern based on a rigid guidewire previously endoscopically placed and coiled inside BD, to ensure it expands and remains stable during the dissection. The technique was used in cases of diverticulectomy concomitant to other prostatic procedures. Methods: This is a multicentric series of laparoscopic and robotic diverticulectomy performed with this original technique in 34 patients. The procedure was concomitant to other prostatic intervention in most of the cases: TURP or bladder neck incision (16); radical prostatectomy (three); Millin adenomectomy (four cases). Surgical procedure: The first step of the procedure endoscopic, consisting of the retrograde insertion of a stiff guidewire inside the BD via cystoscopy; the guidewire is pushed in until it coils inside the diverticulum, and then enlarged to make it visible transperitoneally. The guidewire stretches the diverticulum and guides the dissection up to identify its neck. The primary endpoint is to address the feasibility of the technique by considering the operative time (OT, min) and the complication rate. Results: The median size of the BDs was 5.1 cm. The location of the BD was postero-lateral or posterior in all except one case. Bladder diverticulectomy was laparoscopically performed in 25 and robotically assisted in nine cases. Median OT was 179 min (DS 42). The post-operative course was uneventful for all except two patients with symptomatic urinary tract infections. Conclusions: The use of a stiff guidewire coiling and expanding the BD is a simple and useful trick to aid BD’s identification and dissection; it aids diverticulectomy and is also concomitant to other prostatic procedures. Full article

Background and Objectives: We conducted a systematic review and network meta-analysis to evaluate and compare the perioperative, functional, and oncological outcomes of robot-assisted radical prostatectomy (RARP) and laparoscopic radical prostatectomy (LRP) with open radical prostatectomy (ORP) in patients with prostate cancer. Materials and Methods: A comprehensive literature search was performed in Pubmed, EMBASE, and the Cochrane library for papers published before May 2021. Only studies of patients with prostate cancer that assessed perioperative, functional, and oncological outcomes and reported outcome values were included. We used a Bayesian hierarchical random-effects model to synthesize data from multiple studies, enabling both direct and indirect comparisons of the three surgical approaches (RARP, LRP, ORP) to provide robust estimates of their relative efficacy. This systematic review was registered in PROSPERO (CRD42021282555). Results: A total of 80 studies were finally included in the present study. Biochemical recurrence (BCR) rates were lower for RARP than for ORP (RR 0.713, 95% CrI 0.587–0.869) and LRP (RR 0.672, 95% CrI 0.505–0.895). Compared with ORP, RARP had a significantly lower positive surgical margin (RR 0.893, 95% CrI 0.807–0.985). When compared to ORP, RARP and LRP showed no significant difference in continence (RR 1.057, 95% CrI 0.997–1.124; RR 0.921, 95% CrI 0.845–1.007). When compared to ORP, RARP was significantly more effective on potency (RR 1.201, 95% CrI 1.047–1.402). The potency rate was significantly higher for RARP than for ORP (RR 1.201, 95% CrI 1.047–1.402) and LRP (RR 1.438, 95% CrI 1.191–1.762). There was no difference in the estimated blood loss or the total and major complication rates between RARP, ORP, and LRP. The operation time was longest for LRP. There was no difference in the operation time between RARP and ORP. Conclusions: RARP may be better or comparable to ORP and LRP in terms of oncologic outcomes (PSM and BCR), functional outcomes (potency and incontinence), and perioperative outcomes (EBL, operation time, and total and major complications). Full article

Background/Objectives: Extended pelvic lymph node dissection is a crucial surgical technique for managing intermediate to high-risk prostate cancer. Accurately predicting lymph node metastasis before surgery can minimize unnecessary lymph node dissections and their associated complications. This study assessed the efficacy of various machine learning models for predicting lymph node metastasis in a cohort of Japanese patients who underwent robot-assisted laparoscopic radical prostatectomy. Methods: Data from 625 patients who underwent extended pelvic lymph node dissection or standard dissection with lymph node metastasis between October 2010 and February 2023 were analyzed. Four machine learning models—Random Forest, Light Gradient-Boosting Machine, Logistic Regression, and Support Vector Machine—were used to predict lymph node metastasis. Their performance was assessed using receiver operating characteristic curves, a decision curve analysis, and predictive values at different thresholds. Results: Lymph node metastasis was observed in 34 patients (5.4%). The Light Gradient-Boosting Machine had the highest AUC of 0.924, followed by the Random Forest model with an AUC of 0.894. The decision curve analysis indicated substantial net benefits for both models, particularly at low threshold probabilities. The Light Gradient-Boosting Machine demonstrated superior accuracy, achieving 95.6% at the 0.05 threshold and 96.7% at the 0.10 threshold, outperforming other models and conventional nomograms in the validation dataset. Conclusion: Machine learning models, especially Light Gradient-Boosting Machine and Random Forest, show significant potential for predicting lymph node metastasis in prostate cancer, thereby aiding in reducing unnecessary surgical interventions. Full article

Background and Objectives: To prove the feasibility of continuous spinal extraperitoneal robot-assisted laparoscopic radical prostatectomy (cseRALP) in order to expand the pool of eligible patients. Materials and Methods: According to IDEAL guidelines, a consecutive cohort of patients who underwent cseRALP was enrolled. Pre-, intra-, and post-operative data were collected, with particular focus on safety and oncological outcomes. Results: A total of three patients underwent this technique, with no intra- or post-operative medical complications. Only a grade 1 Clavien–Dindo complication was reported, small urinary leakage treated with an indwelling catheter. Oncological and functional results at month 3 were satisfactory, with no recurrence and no stress incontinence. Conclusions: cseRALP seems to be feasible and safe; further trials are mandatory. Full article

Background: The advantage of a robotic-assisted (RARP) over a laparoscopic (LRP) approach in radical prostatectomy (RP) remains to be demonstrated. Aim: The aim of the study is to use a homogeneous population in real life and single primary surgeon surgery to analyze the oncological and functional results based on the type of surgical approach and pathological features. Methods: This is a prospective trial on non-metastatic prostate cancer (PCa) patients considered after a multidisciplinary decision to conduct a RP, using a RARP or LRP approach. A real-life setting was analyzed at our Urological Departments using homogeneous criteria for the management of PCa cases and a single surgeon experience on 444 cases (284 LRP and 160 RARP). Results: Mean operating time was significantly lower in RARP (153.21 ± 25.1 min) than in LRP (173.33 ± 44.3 min) (p < 0.001). In cases submitted to an extended lymph node dissection (eLND), the mean number of lymph nodes removed was 15.16 ± 7.83 and 19.83 ± 4.78, respectively, in LRP and RARP procedures (p < 0.001), but positive lymph nodes (pN1) were similarly found in 15.8% of LRP patients and 13.6% of RARP patients (p = 0.430). Surgical margins (SM) positivity was not significantly higher in the RARP group (20.0%) when compared to the LRP group (15.9%) (p = 0.145). During the postoperative follow-up, a biochemical recurrence (BCR) was detected in 14.4% and 7.5% of cases in the LRP and RARP group, respectively, (p = 0.014). Better results of PAD tests at 3-month intervals using the RARP approach (mean pad weight 75.57 ± 122 g and 14 ± 42 g, respectively, in LRP and RARP (p < 0.01)) were described. Conclusions: In the comparison between the RARP and LRP approach, a clear advantage of the robotic approach is a significant reduction in operating times, days of hospitalization, and postoperative catheterization compared to laparoscopic surgery. It is not possible to describe any certain oncological advantage both in terms of surgical margins and pathological lymph nodes removed. In RARP cases a reduction to the limit of significance is described in terms of biochemical recurrence. RARP produces a more rapid recovery of urinary continence at 3 months postoperatively without significant advantages in terms of erective potency recovery. Full article

Background and Objectives: Robot-assisted radical prostatectomy (RARP) is a complex surgery with a steep learning curve (LC). No clear evidence exists for how previous laparoscopic experience affects the RARP LC. We report the LC of three surgeons with vast experience in laparoscopy (more than 400 procedures), analyzing the results of functional and oncological outcomes under the “Trifecta” concept (defined as the achievement of continence, potency, and oncological control free of biochemical recurrence). Materials and Methods: The surgical experience of the three surgeons from September 2021 to December 2022, involving 146 RARP consecutive patients in a single institution center, was evaluated prospectively. Erectile disfunction patients were excluded. ANOVA and chi-square test were used to compare the distribution of variables between the three surgeons. LC analysis was performed using the cumulative sum control chart (CUSUM) technique to achieve trifecta. Results: The median age was 65.42 (±7.34); the clinical stage were T1c (68%) and T2a (32%); the biopsy grades were ISUP 1 (15.9%), ISUP 2 (47.98), and ≥ISUP 3 (35%). The median surgical time was 132.8 (±32.8), and the mean intraoperative bleeding was 186 cc (±115). Complications included the following: Clavien–Dindo I 8/146 (5.47%); II 9/146 (6.16%); and III 3/146 (2.05%). Positive margins were reported in 44/146 (30.13%). The PSA of 145/146 patients (99%) at 6 months was below 0.08. Early continence was achieved in 101/146 (69.17%), 6-month continence 126/146 (86%), early potency 51/146 (34.9%), and 6-month potency 65/146 (44%). Surgeons “a”, “b”, and “c” performed 50, 47, and 49 cases, respectively. After CUSUM analysis, the “Trifecta” LC peak was achieved at case 19 in surgeon “a”, 21 in surgeon “b”, and 20 in surgeon “c”. Conclusions: RARP LC to accomplish “Trifecta” can be significantly reduced in surgeons with previous experience in laparoscopy and be achieved at around 20 cases. Full article

Next to prostate-specific antigen, no biochemical biomarkers have been implemented to guide patient follow-up after primary therapy for localized prostate cancer (PCa). We evaluated the prognostic potential of urine N-glycome in terms of event-free survival (EFS) in patients undergoing primary therapy for PCa. The prognostic features of the urine N-glycosylation profile at diagnosis, assessed in 77 PCa patients, were determined in terms of EFS next to standard clinical parameters. The majority of patients were diagnosed with International Society of Urological Pathology grade ≤ 3 (82%) T1–2 tumors (79%) and without pelvic lymph node invasion (96%). The patients underwent active surveillance (14%), robot-assisted laparoscopic prostatectomy (48%), or external beam radiotherapy (37%). Decreased ratios of biantennary core-fucosylation were noted in patients who developed an event, which was linked to a shorter EFS in both the intention-to-treat cohort and all subcohort analyses. Combining the urine N-glycan biomarker with the D’Amico Risk Classification for PCa resulted in an improved nomogram for patient classification after primary therapy. The rate of urine N-glycan biantennary core-fucosylation, typically linked to more aggressive disease status, is lower in patients who eventually developed an event following primary therapy and subsequently in patients with a worse EFS. The combination of urine N-glycan biomarkers together with clinical parameters could, therefore, improve the post-therapy follow-up of patients with PCa. Full article

Aim and Objectives: We aimed to test the predictive value of readily accessible and easily performed post-surgical “bedside tests” on their validity of long-term urinary incontinence (UI) (≥12 months) in patients following robot-assisted laparoscopic radical prostatectomy (RALP). Material and Methods: Patients undergoing RALP between July 2020 and March 2021 were prospectively included and subdivided into two groups based on their pad usage after 12 months (0 vs. ≥1 pad). After catheter removal, patients performed a 1 h pad test, documented the need for pad change in a micturition protocol and received post-voiding residual urine volume ultrasound. Univariate and multivariable analyses were used to demonstrate the predictive value of easily accessible tests applied after catheter removal for UI following RALP. Results: Of 109 patients, 47 (43%) had to use at least one pad (vs. 62 (57%) zero pads) after 12 months. Univariate testing showed a significant difference in urine loss between both groups evaluated by the 1 h pad test performed within 24 h after catheter removal (70% < 10 mL, vs. 30% ≥ 10 mL, p = 0.004) and in the need for pad change within the first 24 h after catheter removal (14% dry pads vs. 86% wet pads, p = 0.003). In multivariable analyses, the combination of both tests (synoptical incontinence score) could be confirmed as an independent predictor for UI after 12 months (p = 0.011). Conclusions: Readily accessible “everyday” diagnostics (pad test/change of pads after catheter removal) following RALP seem to be associated with a higher rate of long-term UI. This finding is crucial since patients with a potentially higher need for patient education and counselling can be identified using these readily accessible tests. This could lead to a higher patient satisfaction and improved outcomes. Full article