Robot-Assisted Versus Open Simple Prostatectomy for Benign Prostatic Hyperplasia in Large Glands: A Propensity Score-Matched Comparison of Perioperative and Short-Term Outcomes

Objective: To report the largest comparative analysis of robotic vs open simple prostatectomy (OSP) for large-volume prostate glands. Materials and Methods: We retrospectively reviewed 103 patients that underwent open and 64 patients that underwent robotic simple prostatectomy from 2012 to 2016 at a single institution. A propensity score-matched analysis was performed with five covariates, including age, body mass index, race, Charlson comorbidity index, and prostate volume. Perioperative, postoperative, and functional outcomes were compared between groups. Results: After propensity score matching there were 59 patients in each group available for comparison. There was no statistically significant difference between groups for all preoperative demographic variables. Robotic compared with OSP demonstrated a significant shorter average length of stay (LOS) (1.5 vs 2.6 days, p < 0.001), but longer mean operative time (161 vs 93 minutes, p < 0.001). The robotic approach was also associated with a lower estimated blood loss (339 vs 587 mL, p < 0.001) and lower percentage hematocrit drop (12.3% vs 19.5%, p = 0.001). Two patients required blood transfusions in the robot group compared with four in the open group, but this was not significant (p = 0.271). Improvements in maximal flow rate, International Prostate Symptom Score, quality of life, postvoid residual, and postoperative prostate-specific antigen levels were similar before and after surgery for both groups, but there was no difference between groups. There was no difference in complications between groups. Conclusion: Robotic simple prostatectomy is a safe and effective treatment for the surgical management of benign prostatic hyperplasia. It provides similar function outcomes to the open approach; however, offers the advantage of reduced LOS and reduced blood loss.