Clinical References
Articles
Robotic Radical Prostatectomy with Continence and Potency Sparing Technique: An Analysis of the First 250 Cases
D. Russell Locke, Ira W. Klimberg and Rick P. Sessions
Urology Center of Florida, Ocala, Florida
Purpose: Robotic radical prostatectomy has emerged as a minimally invasive alternative for the treatment of localized prostate cancer with the potential to improve long-term cure, continence and potency. We report results of our first 250 robotic radical prostatectomies, employing several technical refinements and innovations reflecting our experience with open anatomic radical retropubic prostatectomy.
Materials and Methods: A single surgical team performed 250 robotic radical prostatectomies within a 27-month period. Preoperative patient variables, operative statistics and postoperative results were collected. Prostatectomy specimens were evaluated according to the 2002 TNM classification standards. Urinary and sexual function were determined using the Expanded Prostate Inventory Composite (EPIC) and Sexual Health Inventory for Men (SHIM) quality-of-life instruments.
Results: Mean operative time was 162.3 minutes. Estimated blood loss averaged 73.6 mL. Mean hospital stay was 1.1 days and mean catheterization time was 6.8 days. Positive surgical margins were reported in 6.2% of patients with stage T2 disease. At six months, prostate specific antigen level was undetectable (<0.1 ng/mL) in 96.8% of patients. One week following catheter removal, 84.8% of patients were continent, improving to 98.7% at both 12 and 18 months. Among patients reporting normal preoperative erections (SHIM >21), potency returned more gradually, reaching 85.4% at 12 months and 91.7% at 18 months.
Conclusions: Robotic radical prostatectomy using a continence and potency sparing technique is a technologically advanced ablative and reconstructive procedure that offers a promising approach to the treatment of localized prostate cancer.
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