Efficacy and safety of urethral sparing versus other robot-assisted simple prostatectomy for large volume benign prostatic hyperplasia: a systematic review and meta-analysis.

BACKGROUND

This study aim to evaluate the efficacy and safety of urethra-sparing robot-assisted simple prostatectomy (US-RASP) compared to conventional robot-assisted simple prostatectomy (RASP) for treating large-volume benign prostatic hyperplasia (BPH), with particular attention to preserving ejaculatory function.

METHODS

A thorough search was conducted across PubMed, Web of Science, EMBASE, and Cochrane Library databases for studies published until September 26, 2024. Five cohort studies involving 771 patients met the inclusion criteria. Data on perioperative outcomes, International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF), Male Sexual Health Questionnaire Ejaculatory Dysfunction (MSHQ-EjD), Maximum Flow Rate (Qmax), Post-Void Residual Volume (PVR), Quality of Life (QoL) and complications were extracted and analyzed using RevMan 5.3 and Stata 15.

RESULTS

The meta-analysis revealed that US-RASP was markedly more effective than RASP in preserving ejaculatory function (MSHQ-EjD, WMD 8.09, 95% CI 5.92–10.26, p < 0.0001). No notable differences were identified between the two approaches regarding IPSS, IIEF, Qmax, PVR, QoL, operative time, or intraoperative blood loss and complications. Nonetheless, US-RASP showed benefits in shortening hospital stay and catheterization time.

CONCLUSIONS

US-RASP offers significant benefits in preserving ejaculatory function and is comparable to RASP in terms of safety and efficacy. It is a preferable option for younger patients or those desiring ejaculatory preservation, pending further validation through large-scale, prospective randomized trials.