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Robot-assisted radical prostatectomy following holmium laser enucleation of the prostate: perioperative, functional, and oncological outcomes

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Abstract

Robot-assisted radical prostatectomy with previous holmium laser enucleation of the prostate is challenging, and few studies have analyzed its perioperative, functional, and oncological outcomes. Here we retrospectively evaluated 298 robot-assisted radical prostatectomies, including 25 with and 273 without previous holmium laser enucleation of the prostate, performed in 2015–2022. Regarding perioperative outcomes, operative and console times were significantly longer in the previous holmium laser enucleation of the prostate group. In contrast, the estimated blood loss was similar between groups, and there were no transfusions or intraoperative complications. Multivariable Cox hazard regression analysis of the functional outcomes of postoperative urinary continence showed that body mass index, intraoperative bladder neck repair, and nerve sparing were independently associated factors, whereas a history of holmium laser enucleation of the prostate was not. Similarly, a history of holmium laser enucleation of the prostate was not associated with biochemical recurrence; however, positive surgical margins and seminal vesicle invasion were independent risk factors of biochemical recurrence. Our findings revealed that robot-assisted radical prostatectomy after holmium laser enucleation of the prostate was safe and raised no concerns of postoperative urinary incontinence or biochemical recurrence. Therefore, robot-assisted radical prostatectomy may be a treatment option for patients with prostate cancer after holmium laser enucleation of the prostate.

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Data availability

The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

I am deeply grateful to all of my co-authors.

Funding

The authors declare that no funds, grants, or other support was received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Urology, Jyoban Hospital of Tokiwa foundation, 57 Kaminodai, Nagaya-machi, Jobankamiyu, Iwaki-shi, Fukushima, 972-8322, Japan

    Taro Banno, Kazutaka Nakamura, Yukiko Kouchi & Hiroaki Shimmura

  2. Department of Breast Surgery, Jyoban Hospital of Tokiwa foundation, Iwaki, Japan

    Akihiko Ozaki

  3. Department of Urology, Ohira Clinic, Mito, Japan

    Tadashi Ohira

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  1. Taro Banno
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  2. Kazutaka Nakamura
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  3. Akihiko Ozaki
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  6. Hiroaki Shimmura
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Contributions

All authors contributed to the study conception and design. The material preparation and the data collection and analysis were performed by TB, KN, AO, YK, TO, and HS. The first draft of the manuscript was written by TB, and all authors commented on its various iterations. All authors have read and approved the final manuscript.

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Correspondence to Taro Banno.

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The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Jyoban Hospital of Tokiwa Foundation (24th Jan 2022/No.JHTF-IRB2021.013).

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Informed consent was obtained from all the participants included in the study.

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Banno, T., Nakamura, K., Ozaki, A. et al. Robot-assisted radical prostatectomy following holmium laser enucleation of the prostate: perioperative, functional, and oncological outcomes. J Robotic Surg 17, 2125–2133 (2023). https://doi.org/10.1007/s11701-023-01621-y

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