Perioperative Outcomes of Anatomic Endoscopic Enucleation of the Prostate, Robotic and Open Simple Prostatectomy From a Multi-Institutional Database

Abstract

ObjectiveTo compare the perioperative morbidity of robotic-assisted simple prostatectomy (RASP), anatomical endoscopic enucleation of the prostate (AEEP) and open simple prostatectomy (OSP) for the treatment of benign prostatic obstruction (BPO). MethodsThe national surgical quality improvement program database was queried for AEEP, RASP, and OSP procedures. Clavien-Dindo-graded complications, length of hospital stay (LOS), and operative time were compared among the procedures. To control for the potentially confounding variables, we first conducted a multivariate backward conditional logistic regression, and then resorted to propensity score matching. ResultsWe identified 2867 AEEP, 234 RASP, and 1492 OSP procedures. After matching, the risk of pulmonary, renal, infectious, and thromboembolic adverse events was lower after AEEP but not RASP in comparison with OSP (P < 0.05). In comparison with RASP, AEEP had lower cardiac and thromboembolic events (P < 0.05). When compared with OSP, AEEP had reduced odds of Clavien-Dindo grade I (OR = 0.12; 95% CI 0.10 to 0.16) and II (OR = 0.38; 95% CI 0.24 to 9.58) complications. Also, AEEP had lower odds for grade I and II as well as grade IV complications (OR = 0.30; 95% CI 0.19 to 0.48, and OR = 0.05; 95% CI 0.01 to 0.24, respectively) compared with RASP. ConclusionAEEP and RASP were associated with fewer perioperative adverse events, a shorter LOS and a reduced risk of transfusion compared with OSP. AEEP was associated with overall lower complication rates than RASP and OSP.

Keywords

• benign prostatic obstruction
• endoscopic enucleation of the prostate
• perioperative outcomes
• robotic-assisted simple prostatectomy