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Perioperative and 1-year patient-reported outcomes of Freyer versus Millin versus Madigan robot-assisted simple prostatectomy

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Abstract

Purpose

Robotic-assisted simple prostatectomy (RASP) is an established surgical procedure for the management of obstructive symptoms caused by large adenomas. Traditionally, this is performed according to the trans-vescical (Freyer) or trans-capsular (Millin) technique. We recently described a novel urethra-sparing (Madigan) robotic technique which showed promising preliminary results. In this study, we compared the above techniques for perioperative and 1-year patient-reported outcomes.

Methods

We retrospectively collected data from patients who underwent RASP across the three techniques, performed by two experienced surgeons in our center. We assessed patient self-reported pre-operative and post-operative functional outcomes with validated questionnaires: IPSS, IIEF short form, ICIQ short form, MSHQ Short Form. Continuous and categorical variables were compared between groups using the Mood’s median test and the Chi-square tests, respectively.

Results

Millin, Madigan and Freyer procedures were performed in 23 (51%), 14 (31%) and 8 (18%) cases, respectively. No significant differences were observed for baseline ASA score, BMI, prostate volume, IPSS, IIEF, ICIQ and MSHQ scores (all p ≥ 0.2), as well as post-operative obstructive symptoms relief (IPSS: p = 0.25), continence (ICIQ: p = 0.54), complication rates (p = 0.32) and hospital stay (p = 0.23). Operative time was longer for Madigan procedures (p = 0.05). The 1-year MSHQ and IIEF scores were significantly higher in the Madigan cohort (p = 0.008 and p = 0.04, respectively).

Conclusion

RASP proved to be a safe surgical approach, providing an effective and durable relief of obstructive symptoms at mid-term follow-up regardless of the technique used. The Madigan technique provided significant benefits in terms of self-assessed quality of sexual function.

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Availability of data and material

The datasets generated during this study are available from the corresponding author on reasonable request.

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Funding

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Authors and Affiliations

  1. Department of Urology, IRCCS “Regina Elena” National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy

    Alfredo Maria Bove, Umberto Anceschi, Mariaconsiglia Ferriero, Riccardo Mastroianni, Aldo Brassetti, Gabriele Tuderti & Giuseppe Simone

  2. Department of Urology, “Sapienza” University, Rome, Italy

    Riccardo Mastroianni & Michele Gallucci

Authors
  1. Alfredo Maria Bove
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  2. Umberto Anceschi
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  3. Mariaconsiglia Ferriero
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  4. Riccardo Mastroianni
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  5. Aldo Brassetti
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  6. Gabriele Tuderti
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  7. Michele Gallucci
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  8. Giuseppe Simone
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Contributions

AMB: Protocol/project development, Data collection, Manuscript writing. UA: Data collection, results interpretation. MF: Data collection, Manuscript editing. RM: Data collection, Statistical analysis. AB: Statistical analysis, results interpretation. GT: Project development, Data collection. MG: Study design, interpretation of results, data collection. GS: Project development, results interpretation, Manuscript editing.

Corresponding author

Correspondence to Alfredo Maria Bove.

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Conflict of interest

The authors declare no conflict of interest.

Informed consent

For this study, written consent was obtained from every patient to use their deidentified data. The authors confirm that an Institutional Review Board approved the study and informed consent for this retrospective study was waived according to the national laws.

Research involving human participants and/or animals

This study is a retrospective analysis, therefore, it did not involve human participants and/or animals.

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Bove, A.M., Anceschi, U., Ferriero, M. et al. Perioperative and 1-year patient-reported outcomes of Freyer versus Millin versus Madigan robot-assisted simple prostatectomy. World J Urol 39, 2005–2010 (2021). https://doi.org/10.1007/s00345-020-03391-w

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  • DOI: https://doi.org/10.1007/s00345-020-03391-w

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