Minerva urology and nephrology · 2025
Waterjet ablation therapy vs. urethral-sparing robot-assisted simple prostatectomy for large prostate volumes (>80 mL): results of a retrospective multicentric series according to the standardized BPH6 achievement.
СтатьяМногоцентровое исследованиеСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Anceschi Umberto, Tedesco Francesco, Amparore Daniele, Bologna Eugenio, Siena Giampaolo, Cacciatore Loris, Basile Salvatore, Cocci Andrea, Prata Francesco, Flammia Rocco S, De Cillis Sabrina, Sessa Francesco, Bove Alfredo M, Viola Lorenzo, Iannuzzi Andrea, Ragusa Alberto, Brassetti Aldo, Mastroianni Riccardo, Mirabile Gabriella, Proietti Flavia, Licari Leslie C, Zampa Ashanti, Quarà Alberto, Ortenzi Michele, Checcucci Enrico, Fiori Cristian, Porpiglia Francesco, Minervini Andrea, Pansadoro Vito, Leonardo Costantino, Simone Giuseppe
Аннотация
BACKGROUND: The introduction of minimally invasive techniques for BPH treatment aimed to balance de-obstruction with maintenance of ejaculatory function. The aim of this multicentric series was to compare outcomes of waterjet ablation therapy (WAT) versus urethral-sparing robot assisted simple prostatectomy (us-RASP) for large prostate volumes (PV>80 mL) according to BPH-6 metric.
METHODS: Four institutional BPH datasets were matched and queried for "PV>80 mL" (N.=86), "WAT" (Group A; N.=42) and "us-RASP" (Group B; N.=44). Baseline, perioperative and functional data according to BPH6 composite endpoint were compared between groups. Differences between continuous variables were assessed with t-test or Mann-Whitney U-test depending on their normal or not normal distribution, while Chi-square Test was used for categorical data. A two-sided P<0.05 was considered significant.
RESULTS: Patients treated with WAT showed lower preoperative PSA median values (3.5 vs. 7.07 ng/mL) (P<0.05). Regarding perioperative outcomes, patients treated with us-RASP revealed increased median operative time (110 vs. 70 mins), prolonged bladder irrigation time (24 vs. 37.2 hours), longer median hospital stay (5 vs. 4 days), respectively (all P<0.05). At a median follow-up of 43.7 months (IQR 33.8-49.7), the BPH6 achievement rate was comparable between groups (54.7% vs. 56.8%; P=0.964). In the WAT series 1-year ejaculatory dysfunction rate was 19.1% while in the us-RASP cohort was 13.6%, respectively (P=0.21). Retrospective design and the lack of a propensity-score matching represent main limitations of this study.
CONCLUSIONS: Compared to us-RASP, WAT showed comparable symptom relief and ejaculatory function preservation for prostate gland >80 mL with benefit in terms of main perioperative outcomes at mid-term follow-up.
METHODS: Four institutional BPH datasets were matched and queried for "PV>80 mL" (N.=86), "WAT" (Group A; N.=42) and "us-RASP" (Group B; N.=44). Baseline, perioperative and functional data according to BPH6 composite endpoint were compared between groups. Differences between continuous variables were assessed with t-test or Mann-Whitney U-test depending on their normal or not normal distribution, while Chi-square Test was used for categorical data. A two-sided P<0.05 was considered significant.
RESULTS: Patients treated with WAT showed lower preoperative PSA median values (3.5 vs. 7.07 ng/mL) (P<0.05). Regarding perioperative outcomes, patients treated with us-RASP revealed increased median operative time (110 vs. 70 mins), prolonged bladder irrigation time (24 vs. 37.2 hours), longer median hospital stay (5 vs. 4 days), respectively (all P<0.05). At a median follow-up of 43.7 months (IQR 33.8-49.7), the BPH6 achievement rate was comparable between groups (54.7% vs. 56.8%; P=0.964). In the WAT series 1-year ejaculatory dysfunction rate was 19.1% while in the us-RASP cohort was 13.6%, respectively (P=0.21). Retrospective design and the lack of a propensity-score matching represent main limitations of this study.
CONCLUSIONS: Compared to us-RASP, WAT showed comparable symptom relief and ejaculatory function preservation for prostate gland >80 mL with benefit in terms of main perioperative outcomes at mid-term follow-up.