PE19: Prospective non-randomized trial comparing perioperative data of patients treated by robot-assisted radical prostatectomy and radical retropubic prostatectomy

PE19: Prospective non-randomized trial comparing perioperative data of patients treated by robot-assisted radical prostatectomy and radical retropubic prostatectomy

22 U N M O D E R A T E D P O S T E R P R E S E N T A T I O N S / E U R O P E A N U R O L O G Y S U P P L E M E N T S 13 (2014) 1—60 significant impro...

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U N M O D E R A T E D P O S T E R P R E S E N T A T I O N S / E U R O P E A N U R O L O G Y S U P P L E M E N T S 13 (2014) 1—60

significant improvement between the hydrodissection and standard dissection groups at 6 weeks and 3 months (p <0.05). Conclusions: Hydrodissection of the neurovascular bundle during da Vinci radical prostatectomy improves postoperative International Index of Erectile Function scores. Longer follow-up is needed to evaluate direct impact of hydrodissection on erectile function in patients after da Vinci prostatectomy. PE18 Functional and oncological results of da Vinci radical prostatectomy in obese patients in Russia K. Kolontarev, A. Govorov, P. Rasner, D. Pushkar. Moscow State Medico Stomatological University, Hospital 50, Dept. of Urology, Moscow, Russia Introduction & Objectives: In several studies obesity has been suggested as a risk factor for worse perioperative outcomes in the da Vinci radical prostatectomy. However, the real impact of obesity on perioperative outcomes has not yet been well estimated for robotic radical prostatectomy (RRP). We report our experience with the RRP in obese patients at our department. Material & Methods: Results of 605 da Vinci radical prostatectomy cases were analyzed starting from November 2008. First hundred cases were excluded from final analysis due to the learning curve period. Results of 505 cases of robotic prostatectomy by a single surgeon were prospectively analyzed. Obesity was defined as having a body mass index (BMI) greater than 30. Patients with BMI >30 were compared to those with BMI <30. Specific comparators between the groups were: age, total operating time, estimated blood loss, total prostate specific antigen (PSA), specimen weight, pathological stage, grade and margin, complications, and functional outcomes. We also provide with some details of techniques for surgeons, which may optimize results of the procedure in obese patients. Results: Ninty-seven men were identified as obese. When comparing the two groups, no statistically significant difference (p>0.05) was noted in blood loss (205 versus 180 ml in patients with BMI >30 and 30 and 0.05). There was no difference in positive margin rates in pT2 and pT3 stages in both groups. Pad-free results were slightly better in non-obese group (67% versus 58% in obese patients in 3 months follow-up). The continence rate in patients with a BMI >30 was 87 and 91% in patients with a BMI <30 in 32 months of follow-up period. Nerve-sparing technique was used in 70% cases in non-obese group and 55% cases in obese patients. The erectile function rate in patients with a BMI >30 was 68% and 64% in patients with a BMI <30 in 32 months of follow-up period. Conclusions: Robotic prostatectomy is not associated with increased morbidity in the obese patient. There were no statistically significant differences noted in oncological or functional outcomes between the two groups in 32 months of follow-up period. We believe that da Vinci prostatectomy could be recommended to those obese patients with previously delayed open radical surgery due to the high risk of possible complications. Based on our personal experience we formed some practical recommendations which may help surgeons to avoid unnecessary mistakes and will allow them to achieve better results in robotic surgery of obese patients. PE19 Prospective non-randomized trial comparing perioperative data of patients treated by robot-assisted radical prostatectomy and radical retropubic prostatectomy D. Pushkar, A. Govorov, K. Kolontarev, P. Rasner, V. Diakov, A. Bernikov. Moscow State Medico Stomatological University, Hospital 50, Dept. of Urology, Moscow, Russia Introduction & Objectives: The first robot-assisted radical prostatectomy (RARP) in Russia was performed in 2007. Since then the De-

partment of Urology of MSMSU has acquired more experience in performing RARP procedures than any other institution in the Russian Federation. The aim of our study was to continue the assessment of the perioperative outcomes of two contemporary series of patients treated by RARP or radical retropubic prostatectomy (RRP) in a single institution an to present the final data of this trial. The interim data was presented on ERUS 2012. Material & Methods: We performed a prospective non-randomized study comparing the perioperative data of 100 patients who had undergone RARP, and 100 men after RRP at our institution from November 2010 to July 2012. The two groups were comparable for various clinical and pathological variables including median age (66.7 years), mean PSA value (6.4 ng/ml), clinical stage, Gleason score, Charlson score, Body Mass Index etc. The mean prostate volume was significantly smaller in the RALP group (37 vs 53 cc, p<0.05), as well as the mean International Index of Erectile Function (IIEF) score (10.4 vs 22.4, p<0.05). All RARP cases were performed by a laparoscopicallynaive surgeon having vast surgical experience in RRP. Results: Several perioperative characteristics are summarized in Table 1. Table 1. Perioperative characteristics of patients treated by RARP or RRP

Median operative time, min Median intraoperative blood loss, ml Blood transfusions, % of patients Median in-hospital stay, days Foley catheter removed (median days)

RARP

RRP

p

165 185 7 5 7

104 490 21 10 14

<0.05 <0.05 <0.05 <0.05 <0.05

We observed perioperative complications in 10 (10%) patients undergoing RARP and in 15 (15%) men undergoing RRP (p>0.05). Conclusions: The final data of our study showed better results for RARP compared to RRP in terms of median operative time, intraoperative blood loss, blood transfusion rates, in-hospital stay and catheterization time. The positive surgical margin rates and complication rates did not differ significantly between the two types of procedures. The shift from an open to a robotic approach was facilitated by previous substantial experience in RRP that – at least in our opinion – minimized the learning curve of RARP before obtaining proficiency. PE20 Safety and effectivity of a new robot for flexible ureteroscopy J. Rassweiler 1 , R. Saglam 2 , O. Traxer 3 , D. Hoenig 4 , G. Preminger 5 , A. Muslumanoglu 6 , K. Sarica 7 , A. Armagan 8 , T. Caskurlu 9 , AVROG (Avicenna Roboflex Group). 1 SLK-Kliniken Heilbronn GmbH, Dept. of Urology, Heilbronn, Germany; 2 Medicana International Ankara Hospital, Dept. of Urology, Ankara, Turkey; 3 Paris University Tenon Hospital, Dept. of Urology, Paris, France; 4 Smiths Urology Clinic, Dept. of Urology, New York, United States of America; 5 Duke University, Dept. of Urology, Durham-North Carolina, United States of America; 6 Bagcilar Training and Research Hospital, Dept. of Urology, Istanbul, Turkey; 7 Kartal Training and Research Hospital, Dept. of Urology, Istanbul, Turkey; 8 Bezmialem University, Dept. of Urology, Istanbul, Turkey; 9 Medeniyet University, Dept. of Urology, Istanbul, Turkey Introduction & Objectives: Flexible ureterorenoscopy (FURS) represents a technically challenging procedure requiring specific endourologic skills. Based on preclinical studies, we present early clinical experience with treatments performed by 7 different experienced endourologists (IDEAL phase 2) who have used the Roboflex Avicenna™ device (ELMED, Turkey) developed for remote controlled flexible ureteroscopy. We searched the safety and effectivity of this new device. Material & Methods: After Ethical approval, a total 81 patients (mean age 42, range 6–68) were treated. The stone volumes were calculated by CT software, and single and multiple stones with a maximal total volume of 3000 mm3 were accepted in the study. The patients with