Work

Exploring the promise of robot-assisted single-port transvesical radical prostatectomy: Insights from intermediate-term follow-up

Year: 2025

Type: article

Abstract: • SPTVRARP avoids entry into the peritoneal cavity, preserving the bladder’s natural position and improving perioperative outcomes. • 45% of patients achieved immediate urinary continence. • Preservation of anterior periprostatic structures resulted in 87.5% of patients regaining erections sufficient for penetration at 12 months. • The procedure demonstrated oncologic safety with an estimated 94.1% biochemical recurrence-free survival rate at 26 months. • It also demonstrated low complication and readmission rates. The transition from open to robotic radical prostatectomy has enhanced perioperative outcomes while maintaining oncologic safety. There is a growing focus on approaches that expedite the recovery of functional parameters. In line with this, our team introduced the Single-Port Transvesical Robot-Assisted Radical Prostatectomy (SPTVRARP) and aims to present intermediate-term follow-up outcomes. We assessed patients who underwent surgery between December 2020 and December 2024 with at least 12 months of follow-up. Among 248 patients, most had intermediate-risk prostate cancer. The average age was 63 years, with a median PSA of 5.7 ng/ml. Final pathology mainly indicated ISUP GG2 disease, with 45.2% showing non-organ confined cancer. Surgical margins were negative in 79.1% of cases, and the median hospital stay was 5.6 hours. At discharge, 93.2% did not need opioids. Immediate urinary continence was achieved by 45.1%, increasing to 68.5%, 77.0%, 88.3%, and 95.1% at 6 weeks, 3, 6, and 12 months. Of the 196 patients who underwent nerve-sparing surgery, 63.7% were potent at baseline, with a mean SHIM score of 10 at 12 months. Preserving anterior periprostatic structures led to erections sufficient for penetration in 66.6%, 75.0%, and 87.5% at 3, 6, and 12 months. The estimated BCR-free survival rate at 26 months was 94.1%. Limitations include the single-center, single surgeon design, which restricts result generalizability. SPTVRARP optimizes perioperative outcomes. It shortens hospital stays, reduces opioid use, facilitates early catheter removal, and accelerates urinary continence recovery while ensuring oncologic safety.

Source: Urologic Oncology Seminars and Original Investigations

DOI: 10.1016/j.urolonc.2025.08.015