Robot-Assisted Radical Prostatectomy in Patients with Enlarged Median Lobe: Matched Analysis

Objective: Evaluation of surgical, oncological and functional results in patients with prostate cancer and enlarged median lobe who underwent robot- assisted radical prostatectomy (RARP). Materials and Methods: Medical records of 489 patients who underwent RARP between August 2009 and December 2013 were retrospectively evaluated. Among them, 40 patients who had enlarged median lobe were included in Group 1. Forty patients without median lobe hyperplasia were included with matched analysis (Group 2). Patients who were followed up for 12 months were assessed. Results: No significant differences were found between the two groups in terms of demographic values, erectile function, preoperative PSA levels, prostate dimensions, distribution of clinical stages, Gleason scores and D"Amico risk classification (p˃0,05). Perioperative data revealed that mean operative times were 219.9 ± 64.5 (130-360) min and 185.6 ± 57.1 (120-355) min in Groups 1 and 2, respectively which was significantly prolonged in Group 1 (p˂0.05). Bladder neck reconstruction was performed in Groups 1 (n=14: 5%) and 2 (n=1: 3%). Rates of full continence after removal of urethral catheter on day 7 and at the end of months 1, 3, 6 and 12 were similar in Groups 1 and 2 (p˃0.05). Rates of potency and biochemical recurrence were similar at the end of the postoperative 6 months and one year in Groups 1 and 2 (p˃0.05). Conclusion: RARP in patients with prostate cancer with an enlarged median lobe is a challenging operation with significantly longer operative times. With its inherent procedural difficulties, RARP is a good treatment option in patients with prostate cancer and an enlarged median lobe with its successful surgical dissection and anastomosis possibilities.