title: Transvesical robotic simple prostatectomy: initial clinical experience.
abstract: BACKGROUND
  Despite significant developments in transurethral surgery for benign prostatic hyperplasia (BPH), simple prostatectomy remains an excellent option for patients with large glands.
  
  
  OBJECTIVE
  To describe our technique of transvesical robotic simple prostatectomy (RSP).
  
  
  METHODS
  From May 2011 to April 2013, 25 patients underwent RSP.
  
  
  METHODS
  We performed RSP using our technique.
  
  
  METHODS
  Baseline demographics, pathology data, perioperative complications, 90-d complications, and functional outcomes were assessed.
  
  
  CONCLUSIONS
  Mean patient age was 72.9 yr (range: 54-88), baseline International Prostate Symptom Score (IPSS) was 23.9 (range: 9-35), prostate volume was 149.6 ml (range: 91-260), postvoid residual (PVR) was 208.1 ml (range: 72-800), maximum flow rate (Qmax) was 11.3 ml/s, and preoperative prostate-specific antigen was 9.4 ng/ml (range: 1.9-56.3). Eight patients were catheter dependent before surgery. Mean operative time was 214 min (range: 165-345), estimated blood loss was 143 ml (range: 50-350), and the hospital stay was 4 d (range: 2-8). There were no intraoperative complications and no conversions to open surgery. Five patients had a concomitant robotic procedure performed. Early functional outcomes demonstrated significant improvement from baseline with an 85% reduction in mean IPSS (p<0.0001), an 82.2% reduction in mean PVR (p=0.014), and a 77% increase in mean Qmax (p=0.20). This study is limited by small sample size and short follow-up period. One patient had a urinary tract infection; two had recurrent hematuria, one requiring transfusion; one patient had clot retention and extravasation, requiring reoperation.
  
  
  CONCLUSIONS
  Our technique of RSP is safe and effective. Good functional outcomes suggest it is a viable option for BPH and larger glands and can be used for patients requiring concomitant procedures.
  
  
  RESULTS
  We describe the technique and report the initial results of a series of cases of transvesical robotic simple prostatectomy. The procedure is both feasible and safe and a good option for benign prostatic hyperplasia with larger glands.
authors.affiliation: Institute of Urology, Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, CA, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Leslie
authors.affiliation: Institute of Urology, Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, CA, USA.
authors.forename: Andre Luis de Castro
authors.initials: AL
authors.lastname: Abreu
authors.affiliation: Institute of Urology, Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, CA, USA.
authors.forename: Sameer
authors.initials: S
authors.lastname: Chopra
authors.affiliation: Institute of Urology, Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, CA, USA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Ramos
authors.affiliation: Institute of Urology, Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, CA, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Park
authors.affiliation: Institute of Urology, Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, CA, USA.
authors.forename: Andre K
authors.initials: AK
authors.lastname: Berger
authors.affiliation: Institute of Urology, Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, CA, USA.
authors.forename: Mihir M
authors.initials: MM
authors.lastname: Desai
authors.affiliation: Institute of Urology, Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, CA, USA.
authors.forename: Inderbir S
authors.initials: IS
authors.lastname: Gill
authors.affiliation: Institute of Urology, Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, CA, USA. Electronic address: monisharon@hotmail.com.
authors.forename: Monish
authors.initials: M
authors.lastname: Aron
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D009929:Organ Size; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D011470:Prostatic Hyperplasia / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D012720:Severity of Illness Index; D001743:Urinary Bladder / Q000601:surgery*; D014563:Urodynamics
keywords: Benign prostatic hyperplasia; Robotic surgery; Simple prostatectomy