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Does Presence of a Median Lobe Affect Perioperative Complications, Oncological Outcomes and Urinary Continence Following Robotic-assisted Radical Prostatectomy?

Nurullah Hamidi, Ali Fuat Atmaca, Abdullah Erdem Canda, Murat Keske, Bahri Gok, Erdem Koc, Erem Asil, Arslan Ardicoglu




Purpose: To evaluate of the presence of a median lobe(ML) affect perioperative complications, positive surgical margins(PSM), biochemical recurrence(BCR) and urinary continence(UC) following robotic-assisted radical prostatectomy(RARP).

Materials and Methods: Data of 924 consecutive patients who underwent RARP for prostate cancer (PCa) and who have at least 1-year follow-up were evaluated retrospectively. All patients were divided into two groups: Group 1(n=252) included patients with ML and Group 2 (n=672) included patients without ML. The primary endpoint of this study was to compare complication rates between two groups. The secondary endpoints were to compare PSM, BCR and UC rates.

Results: Both groups were statistically similar in terms of demographics and variables about PCa. Mean prostate volume was higher in Group 1 vs. Group 2 (69± 31 vs. 56±23 mL, p<.001). Total operative time was longer in Group 1 vs. Group 2 (144±38 vs. 136±44 min, p=.01). Biochemical recurrence, PSM, perioperative and postoperative complication rates of our population were 13.6%, 14.9%, 1.7% and 8.7%, respectively. There were no statistical differences in terms of perioperative complication, PSM and BCR rates between the groups(p>0.05). At the first month after RARP, total continence rate was statistically significant lower in Group 1 vs. Group 2 (49.2% and 56.5%, p=.03), respectively. However, there were no significant differences in terms of continence rates at 3rd month, 6th month and 1st-year follow-up.

Conclusions: Due to our experience, the presence of ML does not seem to affect perioperative complication, intraoperative blood loss, PSM and BCR following RARP. However, the presence of ML seems to be a disadvantage in gaining early UC following RARP.


Sarle R, Tewari A, Hemal AK, Menon M. Robotic-assisted anatomic radical prostatectomy: Technical difficulties due to a large median lobe. Urol Int. 2005; 74: 92-4.

Meeks JJ, Zhao L, Greco KA, Macejko A, Nadler RB. Impact of prostate median lobe anatomy on robotic-assisted laparoscopic prostatectomy.Urology. 2009; 73: 323-7.

Huang AC, Kowalczyk KJ, Hevelone ND, et al. The Impact of Prostate Size, Median Lobe, and Prior Benign Prostatic Hyperplasia Intervention on Robot-Assisted Laparoscopic Prostatectomy: Technique and Outcomes. Eur Urol. 2011; 59: 595-603.

Molinari A, Simonelli G, De Concilio B, et al. Is ureteral stent placement by the transurethral approach during robot-assisted radical prostatectomy an effective option to preoperative technique? J Endourol. 2014; 28: 896-8.

Jeong CW, Lee S, Oh JJ, et al. Quantification of median lobe protrusion and its impact on the base surgical margin status during robot-assisted laparoscopic prostatectomy. World J Urol. 2014; 32: 419-23.

Coelho RF, Chauhan S, Guglielmetti GB, et al. Does the Presence of Median Lobe Affect Outcomes of Robot-Assisted Laparoscopic Radical Prostatectomy? J Endourol. 2012; 26: 264-70.

Jenkins LC, Nogueira M, Wilding GE, et al. Median lobe in robot-assisted radical prostatectomy: Evaluation and management. Urology. 2008; 71: 810-3.

Jung H, Ngor E, Slezak JM, Chang A, Chien GW. Impact of median lobe anatomy: does its presence affect surgical margin rates during robot-assisted laparoscopic prostatectomy? J Endourol. 2012; 26: 457-60.

Dindo D, Demartines N, Clavien PA. Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 240: 205-13.

Rassweiler JJ, Rassweiler MC, Michel MS. Classification of complications: is the Clavien-Dindo classification the gold standard? Eur Urol. 2012; 62: 256-8.

Patel SR, Kaplon DM, Jarrard D. A Technique for the Management of a Large Median Lobe in Robot-Assisted Laparoscopic Radical Prostatectomy. J Endourol. 2010; 24: 1899-1901.

Cookson MS, Aus G, Burnett AL, et al. Variation in the defination of biochemical recurrence in patients treated for localized prostate cancer: the american urological association prostate guidelines for localized prostate cancer update panel report and recommendations for a standard in the reporting of surgicl outcomes. J Urol. 2007; 177: 540-5.

Mitropoulos D, Artibarni W, Graefen M, Remzi M, Roupret M, Truss M. Reporting and grading of complications after urologic surgical procedures: an ad hoc EAU Guidelines Panel assessment and recommendations. Eur Urol. 2012; 61: 341-9.

Montorsi F, Wilson TG, Rosen RC, et al. Best practices in robot-assisted radical prostatectomy: recommendations of the Pasadena Consensus Panel. Eur Urol. 2012; 62: 368-81.

Vickers AJ, Savage CJ, Hruza M, et al. The surgical learning curve for laparoscopic radical prostatectomy: A retrospective cohort study. Lancet Oncol. 2009; 10: 475-80.

Srougi M, Nesrallah LJ, Kauffman JR, Nesrallah A, Leite KR. Urinary conti- nence and pathological outcome after bladder neck preser- vation during radical retropubic prostatectomy: A randomized prospective trial. J Urol. 2001; 165: 815-23.

Selli C, De Antoni P, Moro U, Macchiarella A, Giannarini G, Crisci A. Role of bladder neck preservation in urinary continence following radical retropubic prostatectomy. Scand J Urol Nephrol. 2004; 38: 32-7.

Deliveliotis C, Protogerou V, Alargof E, Varkarakis J. Radical prostatectomy: Bladder neck preservation and puboprostatic ligament sparing effects on continence and positive margins. Urology. 2002; 60: 855-8.

DOI: http://dx.doi.org/10.22037/uj.v0i0.4276


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