Robot-assisted transvesical prostatectomy – video

Overview

Introduction: Benign prostatic hyperplasia (BPH) is a common cause of lower urinary tract symptoms. When conservative treatment fails, surgical management is indicated. Robot-assisted transvesical prostatectomy represents a minimally invasive alternative to open surgery. At our department, patients with large adenomas (> 100 mL) are indicated for either HoLEP or robot-assisted transvesical prostatectomy. The procedure is performed using a multi-port system, although recent publications suggest that a single-port approach may represent a promising alternative. A potential advantage of this procedure compared to HoLEP is the avoidance of transurethral instrumentation, which may reduce the risk of urethral strictures and improve early postoperative continence. Material and methods: We present a case of a 76-year-old male with massive benign prostatic enlargement (142 mL) and chronic urinary retention. Preoperative prostatic specific antigen (PSA) level was 14.3 ng/mL; due to a PSA density of 0.10, prostate biopsy wasn’t indicated. The procedure was performed in December 2024. The surgical video demonstrates all key steps of the surgery –⁠ bladder incision, adenoma enucleation, hemostasis, and bladder reconstruction. Operative time was 85 minutes, and 66 g of prostatic tissue was removed. Histopathology confirmed benign hyperplasia. The patient was discharged on postoperative day three, and the catheter was removed 9 days after surgery. The patient is fully continent, with no postvoid residual urine on ultrasound. Postoperative PSA was 2.09 ng/mL. Conclusion: Robot-assisted transvesical prostatectomy is a feasible and safe option for the treatment of BPH. In patients with large adenomas, it may represent an effective alternative to other surgical techniques. Further clinical evaluation is required to better define its role, particularly in comparison with HoLEP.

Keywords:

benign prostatic hyperplasia – robot – transvesical prostatectomy