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Does Prostate Size Matter During Robotic Assisted Radical Prostatectomy?
Jonathan Hwang¹, Christian Debeck*¹, Millie Pevzner*¹, John Lynch², Seyed Ghasemian¹, Mohan Verghese^1
1Washington Hospital Center/Georgetown Univ. Hospital, Washington, DC;²Georgetown Univ. Hospital, Washington, DC

Introduction:
Robotic assisted radical prostatectomy (RAP) has gained great popularity among academic and private urologists alike in recent years. RAP is associated with a steep learning curve. Herein, we have evaluated operative outcomes of our first 250 RAP cases, stratified by prostate size.
Methods:
Clinical outcomes of our first 250 RAP patients, performed by a single surgeon, were evaluated prospectively and stratified according to prostate weight. Patients were separated into 3 groups according to their pathologic prostate weights: Group1 (20-39gm), Group 2 (40-79gm), Group 3 (80-150gm). Clinical parameters analyzed included console time, estimated blood loss (EBL), length of stay (LOS), perioperative complication rates, and time to urinary continence.
Results:
All three groups had comparable preoperative PSA, Gleason score, clinical stage and body habitus. There was a statistically significant difference in robotic console time (p < 0.001), EBL (p = 0.017) and time to continence (p = 0.037) with Group 1 having most favorable outcomes. There was no significant disparity in regard to LOS, perioperative complications or incontinence rates. Two open conversions occurred in Group1 and 2 each due to lack of progression.
Conclusions:
Increasing numbers of practicing urologists have taken interest in performing robotic assisted radical prostatectomy, but the steep learning curve remains the major hurdle. Our data strongly suggests larger prostates are more difficult to remove with longer operative times and higher blood loss during RAP. Patient selection based on prostate size may be prudent in the initial phase of surgeon’s learning curve.

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