title: Does the presence of median lobe affect outcomes of robot-assisted laparoscopic radical prostatectomy?
abstract: OBJECTIVE
  To determine whether the presence of median lobe (ML) affects perioperative outcomes, positive surgical margin (PSM) rates, and recovery of urinary continence after robot-assisted radical prostatectomy (RARP).
  
  
  METHODS
  We analyzed 1693 consecutive patients undergoing RARP performed by a single surgeon. Patients were analyzed in two groups based on the presence or not of a ML identified during RARP. Perioperative outcomes, PSM rates, and recovery of urinary continence were compared between the groups. Continence was assessed using validated questionnaires, and it was defined as the use of "no pads" postoperatively.
  
  
  RESULTS
  A ML was identified in 323 (19%) patients. Both groups had similar estimated blood loss, length of hospital stay, pathologic stage, complication rates, anastomotic leakage rates, overall PSM rates, and PSM rate at the bladder neck. The median overall operative time was slightly greater in patients with ML (80 vs 75 min, P<0.001); however, there was no difference in the operative time when stratifying this result by prostate weight. Continence rates were also similar between patients with and without ML at 1 week (27.8% vs 27%, P=0.870), 4 weeks (42.3% vs 48%, P=0.136), 12 weeks (82.5% vs 86.8%, P=0.107), and 24 weeks (91.5% vs 94.1%, P=0.183) after catheter removal. Finally, the median time to recovery of continence was similar between the groups (median: 5 wks, 95% confidence interval [CI]: 4.41-5.59 vs median: 5 wks, CI 4.66-5.34; log rank test, P=0.113).
  
  
  CONCLUSIONS
  The presence of a ML does not affect outcomes of RARP performed by an experienced surgeon.
authors: Global Robotics Institute, Florida Hospital Celebration Health, Celebration, FL, USA. coelhouro@yahoo.com.br
authors: Rafael F
authors: RF
authors: Coelho
authors: Sanket
authors: S
authors: Chauhan
authors: Giuliano B
authors: GB
authors: Guglielmetti
authors: Marcelo A
authors: MA
authors: Orvieto
authors: Ananthakrishnan
authors: A
authors: Sivaraman
authors: Kenneth J
authors: KJ
authors: Palmer
authors: Bernardo
authors: B
authors: Rocco
authors: Geoff
authors: G
authors: Coughlin
authors: Rayan El
authors: RE
authors: Hassan
authors: Marcos F
authors: MF
authors: Dall'oglio
authors: Vipul R
authors: VR
authors: Patel
mesh_terms: D000368:Aged; D006801:Humans; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D019990:Perioperative Care; D011467:Prostate / Q000473:pathology* / Q000601:surgery*; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D012371:Robotics / Q000379:methods*; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000209:etiology