Robotic-Assisted Radical Prostatectomy Found to Cause Fewer Complications

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Robotic-assisted radical prostatectomy (RARP) for clinically localized prostate cancer is associated with lower rates of complications than retropubic radical prostatectomy (RRP), including infections, bladder neck contracture, and the need for blood transfusions, according to a Swedish study.

A team led by Stefan Carlsson, MD, PhD, of the Karolinska University Hospital in Stockholm, compared 1,253 RARP and 485 RRP patients. All underwent procedures for localized prostate cancer.

Infectious complications developed in 1% of RARP patients versus with 9% of RRP patients, Dr. Carlsson's group reported in Urology (2009; published online ahead of print). The incidence of wound infections was 0.4% in the RARP group compared with 5.9% in the RRP group. Clavien grade IIIb-V complications developed in 3.7% of RARP patients compared with 12.9% of RRP patients. Bladder neck contracture, which developed in 0.2% of RARP patients and 4.5% of RRP patients, was nearly 19 times as likely to develop in RARP patients as in RRP patients.

“One possibility for the lower contracture rate in the RARP group,” the authors explained, “is that a watertight anastomosis probably is performed more often with the robotic technique using a running anastomosis and with better visualization, and therefore there are fewer patients with urine extravasations than in the RRP group.”

RRP patients were four times as likely as RARP patients to require surgery for urinary incontinence. In addition, 58 patients in the RARP group (4.8%) required blood transfusions compared with 112 patients in the RRP group (23%).

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