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Background Information

Open or Robotic Assisted Simple prostatectomy is an option for the treatment of BPH in men who have very large prostates, typically over 80 grams in size. The robotic approach is less invasive, but may not be possible if the prostate is too large.  

Indications

Open or Robotic Assisted Simple prostatectomy is an option for the treatment of BPH in men who have very large prostates, typically over 80 grams in size. The robotic approach is less invasive, but may not be possible if the prostate is too large.  

Testing

You made need the following tests prior to surgery:

  • Cystoscopy
  • Uroflow
  • Prostate Ultrasound
  • Urodynamics (Less common)
  • Urinalysis

Procedure

For RASP, your surgeon will use the daVinci robot remove the central portion of your prostate gland. Surgery is done through 5 small incisions.  The open technique uses an incision below the belly button for the central prostate removal. This will provide you with a larger channel through which to urinate. As a result, the urinary symptoms that led to this surgery should improve markedly following the procedure.

 

After the procedure

This surgery is done in a hospital facility with at least an overnight stay.    After awakening from the surgical procedure, a catheter will have been placed in the bladder and will likely have irrigation running through the catheter in a continuous fashion to avoid blood clotting.  This catheter may be on gentle traction to minimize bleeding.

You may feel the need to urinate, have pain at the tip of the penis or have bladder spasms/cramps with the catheter in place.   Anti-spasm medication will likely be given to help relieve these symptoms. Postoperatively you will be able to, drink and walk. You start off small easy to digest food and then move to a more regular diet within a day or two.  Discharge from the hospital will be dependent on when the bleeding has stopped enough to allow you to go home. Most patients get the catheter out one week later.

Benefits

  • Typically immediate resolution of obstructive symptoms
  • Post-operative irritative symptoms are less common as the effect of this procedure
  • Obtain tissue which is sent to pathology to ensure no cancer present
  • Decreased chance of needing retreatment

Results

Study comparing Robotic Assisted Simple Prostatectomy (RASP) and Holmium Laser Enucleation of the Prostate (HoLEP):

  • IPSS reduction of 20 for RASP vs 18 for HoLEP

Umari, P., Fossati, N., Gandaglia, G. et al. Robotic assisted simple prostatectomy versus holmium laser enucleation of the prostate for lower urinary tract symptoms in patients with large volume prostate: a comparative analysis from a high volume center. J Urol. 2017; 197: 1108

Complications

  • Most common side effects are mild to moderate and include pain or burning with urination, blood in the urine, pelvic pain, urgent need to urinate and/or the inability to control the urge. Most symptoms resolve within two to four weeks after the procedure.

Contraindications

  • Hereditary bleeding disorders
  • Inability to safely undergo general anesthesia due to medical problems
  • Inability to stop anticoagulants
  • Inability to stop antiplatelet agents
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