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Background Indwelling catheterization following radical prostatectomy is used to aid healing and urinary drainage. While early removal is well investigated, prolonged catheterization has only been investigated in terms of urinary incontinence. Other complications such as anastomotic strictures are unexplored so far. This study aims to analyze the sequelae of catheterization lasting more than 14 days after robotic-assisted radical prostatectomy (RARP). Methods A prospective database of 3087 patients undergoing RARP was analyzed, focusing on 180 patients with catheterization exceeding 14 days (Group A) and 88 matched controls (Group B). Outcome measures included subsequent surgeries, complications, and functional outcomes. Results Prolonged catheterization did not significantly increase the need for subsequent surgeries (6% in Group A vs. 7% in Group B, p  = .95). However, anastomotic strictures were more common in Group A (3%) compared to Group B (0%) after exclusion of risk factors. Incontinence rates were similar between groups, although a subgroup analysis revealed higher incontinence rates in patients with catheterization exceeding 28 days. No significant differences were observed in erectile function or quality of life between the groups. Conclusion Prolonged catheterization after RARP does not independently increase the risk of anastomotic strictures in the general population. However, in patients without risk factors, prolonged catheter dwell time may elevate the risk of strictures and subsequent surgeries. Additionally, patients with catheterization exceeding 28 days may experience higher rates of long-term incontinence. Further studies with larger sample sizes are needed to confirm these findings and elucidate the long-term implications of prolonged catheterization.

Precise knowledge of each patient’s index cancer and surrounding anatomy is required for nerve-sparing robot-assisted radical prostatectomy (NS-RARP). Complementary to this, 3D printing has proven its utility in improving the visualisation of complex anatomy. This is the first systematic review to critically assess the potential of 3D printed patient-specific prostate cancer models in improving visualisation and the practice of NS-RARP. A literature search of PubMed and OVID Medline databases was performed using the terms “3D Printing”, “Robot Assisted Radical Prostatectomy” and related index terms as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eight articles were included; six were identified via database searches, to which a further two articles were located via a snowballing approach. Eight papers were identified for review. There were five prospective single centre studies, one case series, one technical report and one letter to the editor. Of these articles, five publications (62.5%) reported on the utility of 3D printed models for NS-RARP planning. Two publications (25%) utilised 3D printed prostate models for simulation and training, and two publications (25%) used the models for patient engagement. Despite the nascency of the field, 3D printed models are emerging in the uro-oncological literature as a useful tool in visualising complex anatomy. This has proven useful in NS-RARP for preoperative planning, simulation and patient engagement. However, best practice guidelines, the future regulatory landscape, and health economic considerations need to be addressed before this synergy of new technologies is ready for the mainstream.

Robot-assisted radical prostatectomy (RARP) has emerged as the predominant surgical approach globally, and various techniques have been proposed to improve functional outcomes. Despite these advances, however, functional impairment associated with surgery remains a major concern that affects patients' quality of life. Retzius-sparing RARP (RS-RARP) has been proposed as a surgical technique to preserve the Retzius space, and increasing evidence has demonstrated its effectiveness. However, the effect of RS-RARP on other functions remains unknown. Although some reports show the positive effect of Retzius-sparing RARP (RS-RARP) on urinary incontinence, the effects on other functions remain unknown. The present study retrospectively analyzed 132 patients who underwent RARP at Kitasato University Hospital between January 2020 and July 2021 (49 and 83 patients in the RS-RARP and conventional RARP groups, respectively). We compared the functional outcomes of RS-RARP and conventional RARP (C-RARP) using the Expanded Prostate Cancer Index Composite (EPIC). In addition, sexual function was compared among patients who underwent nerve-sparing procedures. Our findings revealed that, even at 12 months postoperatively, RS-RARP demonstrated significant preservation of urinary continence ( < 0.01) and sexual function compared to C-RARP ( = 0.03). No significant differences were observed in the bowel or hormonal domains. Even in patients who underwent nerve-sparing surgery, the EPIC score 12 months postoperatively was significantly higher with RS-RARP than with C-RARP ( < 0.01). RS-RARP tended to result in positive surgical margins more often than C-RARP (RS-RARP: 44.9%, C-RARP: 28.9%, = 0.06), without affecting the rate of biochemical recurrence (RS-RARP: 14.2%, C-RARP: 15.7%, = 0.81). Our results suggest a potential advantage of RS-RARP in preserving both urinary and sexual function.

A total of 739 patients underwent RARP as initial treatment for PCa from November 2011 to October 2018. Data on BCR status, clinical and pathological parameters were collected from the clinical records. After excluding cases with neoadjuvant and/or adjuvant therapies, presence of lymph node or distant metastasis, and positive SM, a total of 537 cases were eligible for the final analysis. The median follow-up of experimental cohort was 28.0 (interquartile: 18.0–43.0) months. We identified the presence of International Society of Urological Pathology grade group (ISUP-GG) ≥ 4 (Hazard ratio (HR) 3.20, 95% Confidence Interval (95% CI) 1.70–6.03, P < 0.001), lymphovascular invasion (HR 2.03, 95% CI 1.00–4.12, P = 0.049), perineural invasion (HR 10.7, 95% CI 1.45–79.9, P = 0.020), and maximum tumor diameter (MTD) > 20 mm (HR 1.9, 95% CI 1.01–3.70, P = 0.047) as significant factors of BCR in the multivariate analysis. We further developed a risk model according to these factors. Based on this model, 1-year, 3-year, and 5-year BCR-free survival were 100%, 98.9%, 98.9% in the low-risk group; 99.1%, 94.1%, 86.5% in the intermediate-risk group; 93.9%, 84.6%, 58.1% in the high-risk group. Internal validation using the bootstrap method showed a c-index of 0.742 and an optimism-corrected c-index level of 0.731. External validation was also carried out using an integrated database derived from 3 other independent institutions including a total of 387 patients for the final analysis. External validation showed a c-index of 0.655. In conclusion, we identified risk factors of biochemical failure in patients showing negative surgical margin after RARP and further developed a risk model using these risk factors.

Compare surgical outcomes of Robot‑Assisted Radical Prostatectomy (RARP) between patients with and without depression. This retrospective study included consecutive patients who underwent RARP at three tertiary hospitals between January 2021 and December 2023. Patients were divided into intervention and control groups based on the presence of a confirmed diagnosis of depression and the use of antidepressants for more than six months. prior to surgery. Depression, lower urinary tract symptoms (LUTS), and overall quality of life were assessed using the Self‑Rating Depression (SDS), Patient Health Questionnaire (PHQ), International Prostate Symptom Score (IPSS), and 36‑Item Short Form Health Survey (SF-36) scales. Other parameters included demographic characteristics, surgery-related indicators, and urinary incontinence. A total of 245 men underwent RARP surgery, and 205 patients (84%) completed the preoperative surveys and were analyzed. There were no significant differences in the demographic characteristics, initial PSA level, Gleason score, prostate volume, and T staging between the two groups. Additionally, both groups showed significant improvements in SDS scores, IPSS, SF-36-VT scores, and PHQ scores at the sixth month postoperatively compared to those preoperatively (all P  < 0.05). Compared to the control group, the intervention group had higher preoperative and postoperative SDS and PHQ scores as well as lower SF-36 VT scores. Although there was no difference in the preoperative IPSS between the two groups, the intervention group had higher postoperative IPSS and lower rates of urinary incontinence recovery (all P  < 0.05). Patients undergoing RARP who received preoperative antidepressant treatment for depression showed similar clinical symptom improvement post-surgery compared to those without depression; however, they experienced relatively more severe LUTS.

IntroductionIt is important for robotic surgery to be cost-effective, especially by reducing the length of stay (LOS). Therefore, we developed a protocol for day-case robot-assisted radical prostatectomy (RARP). This study aimed to validate this as a safe practice of care and to assess the potential benefits to the hospital and patient.MethodsIn this single-centre study, all patients booked for RARP between April 2022 and October 2022 were screened for suitability for day case. All tumour types were included. Exclusion criteria were a history of complex abdominal surgeries, salvage prostatectomy, body mass index (BMI) > 35 and patient living alone or > 150 km away from the hospital. All day-case RARPs were performed as a morning case with a protocol for review throughout the day with evening discharge if mobilising independently and eating/drinking well. The primary outcome of the study was success rate of discharge home on day of surgery (DOS) with secondary outcomes of readmissions and complications. A patient questionnaire was completed at home including both visual analogue scale (VAS) for pain and satisfaction rating.ResultsForty-five patients underwent day-case RARP over a 6-month period with minimum of 30 days of follow-up. 41/45 (91%) had successful DOS discharge home. The four admissions overnight were due to dizziness, low oxygen saturation, intraoperative complications and a diagnosis of COVID-19. There were no readmissions and no 30-day complications. The most common issues at home were catheter discomfort and constipation with low mean VAS pain score and low nausea reported. The overall patient satisfaction rating was very high at 4.8/5, and 97% said they would recommend to a family member. The cost saving for the hospital was 400 pounds per patient.ConclusionDay-case procedure is a viable, safe and efficient pathway for appropriately selected and counselled patients undergoing RARP.

Objectives: We attempt to assess whether prostate-specific antigen decline rate in the first month (PSADR1M = postoperative PSA in the first month/initial PSA) acts as a predictor for biochemical recurrence (BCR) and to evaluate other preoperative and postoperative variables that may predict BCR following robot-assisted laparoscopic prostatectomy (RARP). Method: Based on the D’Amico risk classification system, 777 patients who underwent RARP for localized prostate cancer were classified into a low/intermediate-risk group (n = 435) and a high-risk group (n = 342). The predictors of BCR were identified by univariate and multivariate logistic regression analyses. The area under the curve (AUC) and optimal cutoff values of PSADR1M were determined by receiver operating characteristic (ROC) analysis. Kaplan–Meier curves for biochemical recurrence-free survival (BRFS) rates were stratified by optimal cutoff values of PSADR1M. Results: Effective predictors of BCR in the entire cohort included pT3 (p < 0.001), pathological Grade Group (pGG3, pGG4+5) compared to pGG1+2 (p < 0.001, p = 0.017), positive surgical margins (PSM) (p < 0.001), seminal vesicle invasion (SVI) (p = 0.006), and PSADR1M ≥ 0.62% (p < 0.001). ROC analysis showed that PSADR1M as a predictor for BCR had an AUC of 0.762 for the whole cohort, and 0.821 for the high-risk group, respectively. The optimal cutoff values of PSADR1M were 0.62% in the whole cohort, and 0.68% in high-risk group. Conclusions: As an effective predictor of BCR, PSADR1M can assess the tumor status of prostate cancer patients intuitively and effectively after RARP, especially in the high-risk group.

Purpose This study aimed to develop a novel model that combines both clinical and image-based parameters to predict early recovery of urinary incontinence after robotic-assisted radical prostatectomy (RARP) more easily and precisely. Materials and methods We retrospectively enrolled data from patients who underwent RARP performed by a single surgeon. Clinical parameters were collected through medical chart review. All patients received cystography one week after RARP to evaluate the anastomosis healing condition. All cystography images were analyzed by a single radiologist who was blinded to the clinical status of the patients. Multivariate analysis was performed to select significant predictors for early post-prostatectomy incontinence (PPI) recovery, defined as being pad-free within four weeks after surgery. Results A total of 293 patients were enrolled in this study. Among them, 26.7% experienced immediate dryness after surgery, while 47.6% achieved being pad-free within one month. The overall continence rate was over 90% six months after surgery. In univariate analysis, factors associated with early PPI recovery were BMI, T stage, NVB preservation, surgical margin status, downward bladder neck, and bladder neck angle on cystography. BMI, NVB preservation, and downward bladder neck remained significant in multivariate analysis (p-values = 0.041, 0.027, and 0.023, respectively). A nomogram model was established based on these three predictors. Conclusion This is the first model to combine preoperative clinical factors, peri-surgical factors, and postoperative image-based factors to predict PPI recovery after RARP. This model can assist clinicians in taking optimal actions for PPI and also reduce patient anxiety.

Purpose Positive surgical margins (PSM) after robot-assisted radical prostatectomy (RARP) for prostate cancer (PCa) can increase the risk of biochemical recurrence and PCa-specific mortality. We aimed to evaluate the impact of multidisciplinary team meetings (MDTM) on reducing the incidence of PSM following RARP. Methods We retrospectively collected the clinical data of consecutive patients undergoing RARP at Hiroshima University between February 2017 and October 2023. The MDTM, comprising a radiologist, uropathologist, and urologist, reviewed the preoperative magnetic resonance imaging (MRI) and prostate biopsy results of each patient before RARP and considered the areas requiring attention during RARP. Surgeons were categorized as experienced or non-experienced based on the number of RARP procedures performed. Results In the pT2 population, the PSM rate was significantly lower in cases evaluated using the MDTM than in those not (11.1% vs. 24.0%; p  = 0.0067). Cox regression analysis identified that a PSA level > 7 ng/mL (hazard ratio 2.2799) and nerve-sparing procedures (hazard ratio 2.2619) were independent predictors of increased PSM risk while conducting an MDTM (hazard ratio 0.4773) was an independent predictor of reduced PSM risk in the pT2 population. In the pathological T3 population, there was no significant difference in PSM rates between cases evaluated and not evaluated at an MDTM. In cases evaluated at an MDTM, similar PSM rates were observed regardless of surgeon experience (10.4% for non-experienced and 11.9% for experienced surgeons; p  = 0.9999). Conclusions An MDTM can improve the PSM rate of pT2 PCa following RARP.

Background/Objectives: Robot-assisted radical prostatectomy (RARP) for the treatment of prostate cancer (PCa) has been standardized over the last 20 years. At our institution, only n = 3 rob arms are used for RARP. In addition, n = 2, 12 mm lap trocars are placed for the bedside assistant symmetrically at the midclavicular lines, which allows for direct pelvic triangulation and greater involvement of the assisting surgeon. The aim of our study was to compare surgical and perioperative outcomes of RARP performed using our alternative trocar placement with no fourth robotic arm in the subgroups of experienced attending surgeons and post-graduate residents as bedside assistants. Residents’ satisfaction was also explored. Methods: RARPs performed within the urology residency program between 2019 and 2024 were retrospectively analyzed. Only rob procedures performed using our 3+2 trocars configuration were included. Intra- and postoperative outcomes, as well as long-term functional outcomes including continence recovery and potency, were assessed, stratified by the level of expertise of the bedside assistant, i.e., an experienced attending or post-graduate Year I–III resident. Satisfaction of residents assigned to the two groups during their robotic rotation was evaluated considering three domains with a score from 1 to 10: insight into surgical procedure, confidence level, and gratification level. Results: Out of n = 281 RARP procedures, the bedside assistant was an attending in 104 cases and a resident in 177. Operative time was found to be slightly longer in cases where the second operator was a resident (attendings vs. residents: 134 ± 40 vs. 152 ± 24; p < 0.001). Postoperative hospitalization time was longer in patients in the resident group (attendings vs. residents: 3.9 ± 1.6 vs. 4.3 ± 1 days; p = 0.025). However, cases where the second operator was a resident had a lower rate of positive surgical margins, with rates of 19.7% in the resident and 43.3% in the attending surgeon cohorts (OR = 0.32; 95% CI 0.18–0.55). This difference remained significant in multivariate analysis. There was no significant difference in postoperative blood transfusion rates (attendings vs. residents: 1.9% vs. 1.2%; p = 0.6). Similarly, long-term functional outcomes in terms of erectile dysfunction and urinary incontinence rates mostly overlapped between groups. The mean score in all three domains evaluating residents’ satisfaction was significantly higher when residents actively participated in the surgical procedure as bedside assistants (p = 0.02, p = 0.004, and p < 0.001, respectively, for insights into surgical procedure, confidence level, and gratification level). Conclusions: These findings provide insight into how an alternative port positioning during RARP could improve the involvement of the bedside assistant, particularly residents, without compromising perioperative outcomes or surgical safety.