Publication:

Comparison of urethral-sparing versus non urethral-sparing techniques of robot-assisted simple prostatectomy: a systematic review and meta-analysis of sexual, functional, and surgical outcomes

Simple prostatectomy (SP) with urethral preservation offers various benefits. Recent advancements in technology have made urethral-sparing robot-assisted simple prostatectomy (US-RASP) more feasible. This systematic review compares the efficacy of US-RASP to non-urethral-sparing robot-assisted simple prostatectomy (Non-US-RASP). A systematic literature search was conducted on PubMed, Scopus, ProQuest, Cochrane Library, and ScienceDirect, following PRISMA 2020 guidelines up to September 2024. Meta-analyses of sexual, functional, and surgical outcomes were performed using Review Manager version 5.4. The risk of bias was assessed with the Newcastle-Ottawa scale (NOS). Six observational studies involving 615 patients were included (332 US-RASP versus 283 non-US-RASP). US-RASP significantly improved sexual outcomes, with higher 6-month ejaculatory preservation (OR 31.77, 95% CI: 13.28 to 76.02, p<0.001) and a higher 12-month MSHQ-EjD SF score (MD 6.38, 95% CI: 5.90 to 6.85, p<0.001). Surgical outcomes favored US-RASP with shorter catheterization time (MD -2.67, 95% CI: -4.63 to -0.71, p=0.008) and reduced length of stay (MD -1.39, 95% CI: -2.51 to -0.28, p=0.01). However, US-RASP was associated with a higher 12-month PVR score (MD 14.00, 95% CI: 12.33 to 15.68, p<0.001). This meta-analysis suggests that US-RASP is an effective alternative to Non-US-RASP, demonstrating better sexual and surgical outcomes despite a higher PVR. However, these findings should be confirmed with a well-designed larger randomized trial.