Total anatomical reconstruction during robot-assisted radical prostatectomy in patients with previous prostate surgery

BACKGROUND: In the literature there are conflicting conclusions for radical prostatectomy (RP) after previous surgery for benign prostatic hyperplasia (BPH). The advent of robot-assisted radical prostatectomy (RARP) has allowed technical advances in preservation and reconstruction of the anatomical structures. Despite the robotic approach, the discordant oncological and functional results between different series did not permit final conclusions. METHODS: In our Department, starting from June 2013, we performed a total anatomical reconstruction (TAR) technique during robot-assisted RP for early recovery of urinary continence. We have retrospectively reviewed all the patients who underwent RARP with TAR procedure with a previous history of prostate surgery for BPH from June 2013 to April 2017 at our Department with a minimum follow-up period of 12 months. All the procedures considered were performed by a single surgeon (F.P.). Preoperative, intraoperative events, complications and functional and oncological results have all been collected. We found 40 patients with previous BPH surgery with adequate preoperative information and postoperative follow-up. RESULTS: RARP was performed successfully in all patients without need for open conversion. No major intraoperative complications were encountered. In no cases blood transfusion was needed. All the complications recorded are Clavien grade I (20%). Continence rate at one, four, 12, 24, and 52 weeks from catheter removal was 77.5%, 82.5%, 90%, 92.5%, and 95%, respectively. CONCLUSIONS: In our experience patients with prostate cancer and a previous surgery for BPH should be managed as naïve patients. RARP is a safe and feasible procedure with no major risks of complications, provided that it is performed by a skilled robotic surgeon.