Scarcella S, et al. Investig Clin Urol. 2021 Oct;62:e78. https://doi.org/10.4111/icu.20210297

Introduction and objectives Robot-Assisted Simple Prostatectomy (RASP) and Holmium Laser Enucleation of the prostate (HoLEP) are both well-established, minimally-invasive surgical treatment options for lower urinary tract symptoms caused by benign prostatic enlargement. We have reported the first comparative analysis of both techniques in patients with prostates of 200ml. Materials & methods Between 2009 and 2020 a total of 53 patients with a prostate volume of 200ml were surgically treated at OLV Hospital Aalst (Belgium): 31 underwent RASP and 22 underwent HoLEP. Preoperative and postoperative assessments included uroflowmetry with maximum urinary flow rate (Qmax) and post-void residual volume (PVR), as well as the International Prostate Symptom Score (IPSS) and quality of life (IPSS-QoL). The complication rates were evaluated according to the Clavien-Dindo Classification. Results Patients treated with RASP had significantly larger prostate volumes compared to HoLEP (median 226 vs. 204.5 ml, p=0.004). After a median follow-up of 14 months, both groups showed a significant improvement in the maximum flow rate (+10.60 vs. +10.70 ml/s, p=0.724) and a reduction of the IPSS score (-12.50 vs. -9, p=0.246) as well as improvement of the QoL (-3 vs. -3, p=0.880). Median operative time was similar in both groups (150 vs. 132.5 min, p=0.665). The amount of resected tissue was lower in the RASP group (134.5 vs. 180 g, p=0.029) and there was no significant difference in postoperative PSA (1.2 vs. 0.8 ng/ml, p=0,112). Despite a similar median catheterization time (3 vs. 2 days, p=0.748), the median hospitalization time was shorter in the HoLEP group (4 vs. 3 days, p=0.052). Complication rates were similar in both groups (32% vs. 36%, p=0.987). Conclusion Our results suggest similar outcomes for RASP and HoLEP in patients with very large prostates 200ml. These findings will require external validation at other high-volume centers.

Kidney cancers account for approximately 2% of all newly diagnosed cancer in 2020. Among the primary treatment options for kidney cancer, urologist may choose between radical or partial nephrectomy, or ablative therapies. Nowadays, robotic-assisted partial nephrectomy (RAPN) for the management of renal cancers has gained popularity, up to being considered the gold standard. However, RAPN is a challenging procedure with a steep learning curve. In this narrative review, different imaging technologies used to guide and aid RAPN are discussed. Three-dimensional visualization technology has been extensively discussed in RAPN, showing its value in enhancing robotic-surgery training, patient counseling, surgical planning, and intraoperative guidance. Intraoperative imaging technologies such as intracorporeal ultrasound, near-infrared fluorescent imaging, and intraoperative pathological examination can also be used to improve the outcomes following RAPN. Finally, artificial intelligence may play a role in the field of RAPN soon. RAPN is a complex surgery; however, many imaging technologies may play an important role in facilitating it.

Reasons why significant prostate cancer is still missed in early stage were investigated at the 22nd National SIEUN (Italian Society of integrated diagnostic in Urology, Andrology, Nephrology) congress took place from 30th November to 1st December 2020, in virtual modality. Even if multiparametric magnetic resonance (MR) has been introduced in the clinical practice several, limitations are emerging in patient with regular digital rectal examination (DRE) and serum prostate specific antigen (PSA) levels approaching the normal limits. The present paper summarizes highlights observed in those cases where significant prostate cancer may be missed by PSA or imaging and DRE. The issue of multidisciplinary interest had been subdivided and deepened under four main topics: biochemical, clinical, pathological and radiological point of view with a focus on PI-RADS 3 lesions.