Retro-apical transection of the urethra during robot-assisted laparoscopic radical prostatectomy in an Asian population

Retro-apical transection of urethra during RARP in an Asian population was found to be feasible. A dedicated team, using robot-assisted surgery, with a skillful assistant are required for the procedure to become standard practice. We would recommend the retro-apical approach for all patients receiving RARP, as it was not found to increase surgical risk or complication. The continence rate at 3 months and 6 months were similar between two groups (70% and 95% in retro-apical group vs 60% and 90% in anterior-apical group).

Objective: To assess the feasibility of retro-apical transection of the urethra during robot-assisted radical prostatectomy (RARP) in an Asian population.

Patients and methods: Eighty consecutive patients with clinically localized prostate cancer underwent RARP performed by a single surgeon. Patients who underwent retro-apical or anterior-apical urethral transection during RARP were allocated to Group 1 or Group 2, respectively. Preoperative clinical characteristics were recorded, pelvic bone measurements taken and prostatic apex shape was assessed using magnetic resonance imaging. Operating characteristics were compared between the groups and pathological outcomes were assessed.

Results: Of the 80 patients, 75% were in Group 1 and 25% in Group 2. Pelvic bone size and apex shape were similar between the two groups. Group 2 had a significantly higher mean (sd) preoperative body mass index (BMI) than Group 1 (27.43 [4.15] vs 23.50 [2.71] kg/m(2); P < 0.001) and significantly higher prostate weight than Group 1 (52.00 [31.89] vs 36.55 [11.57] g; P < 0.05). More of those in Group 2 than in Group 1 had undergone previous transurethral resection of the prostate ([TURP] 25% vs 1.67%; P = 0.003) and the mean tumour volume in Group 2 was significantly higher than in Group 1 (15.17 vs 8.10 mL; P = 0.049). The incidence of retro-apical transection of the urethra was 62.5% and 82.5% in the initial 40 cases and subsequent 40 cases, respectively (P = 0.02).

Conclusion: High BMI, larger prostate volume and previous TURP, but not pelvic bone size or apex shape, might hinder retro-apical transection of the urethra.