Abstract:

Objective: We aimed to investigate the effect of the presence of median lobe (ML) in the learning curve on perioperative, oncological and functional outcomes. Material and Methods: We analyzed 38 consecutive patients undergoing RALP in our clinic between July 2017 and October 2019.Patients were operated by the same surgery team on the first learning curve. They were analyzed in two groups according to the presence or absence of a ML determined during RARP. Perioperative, oncological and functional results were compared between the groups. Results: Prostatic ML was detected in 10 (26.3%) of the patients included in the study.Prostate specific antigen (PSA), body mass index (BMI), length of hospital stay, perioperative and postoperative complication rates were similar in both groups (p <0.01). Surgical margin positivity rate was 20% (2/10) in the ML group and 10.7% (3/28) in the ML group.Numerical differences between the groups were not statistically significant (p <0.01). Nevertheless, prostate volume (p = 0.008) and estimated blood loss (TCC) (p = 0.001) were significant in favor of patients with median lobes. Although the average cantilever time was slightly higher in patients with ML, these numerical differences were not statistically significant (p <0.01). Bladder neck reconstruction rates were 100% (100%) in the ML group and 14% (4/28) in the ML-free group (p = 0.001). Continence rates between patients with and without ML were at 4 weeks (20% to 35%) after catheter removal, at 12 weeks (70% to 64.2%) and at 24 weeks (90% to 89.2%). No statistically significant difference was observed at all times. Conclusion: Learning curve, we think that RALP can be applied safely and effectively in challenging cases in centers without high surgical experience. When we compared the oncological, functional and complication rates of patients without ML in our initial series, we obtained results consistent with the literature.

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