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Single-port transvesical simple prostatectomy for the surgical treatment of benign prostatic hyperplasia: functional and continence outcomes

Prostate Cancer and Prostatic Diseases volume 28, pages 451–456 (2025)Cite this article

Subjects

Abstract

Background

Robot-Assisted Simple Prostatectomy (RASP) is recommended for the treatment of large prostate glands. The introduction of the Single-Port (SP) platform in 2018 has enabled transvesical approach to SP-RASP with promising outcomes. Our aim was to describe the functional and urinary continence outcomes of SP-RASP.

Methods

Clinical and surgical data from all consecutive patients who underwent transvesical SP-RASP between February 2020 and March 2024 were collected in a prospectively maintained institutional dataset and retrospectively analyzed. All procedures were performed using the da Vinci SP platform without any conversions to open surgery. Postoperative outcomes were gathered and analyzed, with a particular focus on the incidence of urinary incontinence (UI) and the time to continence recovery.

Results

Overall, 89 patients underwent SP-RASP, with a median prostate size of 110 grams (90–171.5) and a median PSA level of 5.5 mg/dl (2.77–10.93). All patients were on at least one prostate medication prior to surgery. Preoperative evaluations showed a median International Prostate Symptoms Score (IPSS) of 23 (20-27), Quality of Life (QoL) of 4 (3-5), and Post-voiding Residual (PVR) of 153 ml (60–400). The median operative time was 180 min (164–200), with a median estimated blood loss of 100 ml (30–180). Postoperatively, no patients required continuous bladder irrigation. The median postoperative opioid intake was 6.5 morphine equivalents (0–10), with over 78% not requiring narcotics after discharge. Overall, 77.5% were same day discharged. No Clavien-Dindo > 2 complications were recorded. The median follow-up time was 18 (7-35) months. At the last postoperative urological evaluation, the median IPSS was 5 (3-7), QoL was 1 (0-2), and PVR was 10 ml (0-25). Only 4 patients (4.5%) experienced UI postoperatively, and all were continent within 3 months.

Conclusions

The UI incidence rate and functional outcomes of SP-RASP are very encouraging, likely due to precise adenoma and urethra dissection and bladder neck reconstruction. This approach also allows for same-day discharge.

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Fig. 1: Prostate adenoma enucleation steps.
Fig. 2: Reconstructive phase, with the advancement of the posterior bladder mucosal flap and bladder neck reconstruction at 3 o’clock and 9 o’clock.

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Data availability

The data associated with the paper are not publicly available, but they are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Urology, University of Illinois at Chicago, Chicago, IL, USA

    Matteo Pacini, Luca Lambertini, Giulio Avesani, Juan R. Torres Anguiano, Luca Morgantini, Ruben Sauer Calvo, Hakan B. Haberal & Simone Crivellaro

  2. Urology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy

    Matteo Pacini, Alessandro Zucchi & Riccardo Bartoletti

  3. Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy

    Luca Lambertini & Andrea Minervini

  4. Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy

    Giulio Avesani

  5. University of Illinois at Chicago, College of Medicine, Chicago, IL, USA

    Alec Martin

  6. Division of Urology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, 10043, Turin, Italy

    Gabriele Bignante

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Contributions

M.P., L.L., S.C. have given a substantial contribution to the design of the study; M.P., G.A., A. Ma., R.B. contributed in the first draft of the manuscript; M.P., S.C., L.M., L.L., R.C., G.B., H.H. have given their contribution in data collecting and data analysis; G.P., H.H., M.P., A.Z., S.C., J.T., A.M., revised the manuscript critically. All Authors have participated to drafting the manuscript. All Authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Matteo Pacini.

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Competing interests

Dr. Simone Crivellaro is a consultant for Intuitive, other authors have nothing to disclose.

Ethics approval and consent to participate

Institutional review board approval (protocol n° 2017-0152 from Office of Vice Chancellor for Research, University of Illinois at Chicago) was obtained previously to data collecting and analysis. This study was conducted in accordance with ethical principles given by the Helsinki Declaration about clinical studies on human participants, and written informed consent was obtained from all subjects.

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Supplementary information

41391_2024_923_MOESM1_ESM.docx (download DOCX )

Supplementary Table. Complications rate and Urinary Incontinence rate according to previous prostate biopsy and incidental PCa finding.

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Pacini, M., Lambertini, L., Avesani, G. et al. Single-port transvesical simple prostatectomy for the surgical treatment of benign prostatic hyperplasia: functional and continence outcomes. Prostate Cancer Prostatic Dis 28, 451–456 (2025). https://doi.org/10.1038/s41391-024-00923-y

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