• Urology · Aug 2008

    Meta Analysis Comparative Study

    Outcomes of retropubic, laparoscopic, and robotic-assisted prostatectomy.

    • J Kellogg Parsons and J Lisette Bennett.
    • Division of Urology, University of California San Diego School of Medicine, San Diego, California 21287, USA. plane@ucsd.edu
    • Urology. 2008 Aug 1;72(2):412-6.

    ObjectivesTo compare outcomes of radical retropubic, laparoscopic, and robotic-assisted prostatectomy using evidence-based analysis.MethodsWe performed meta-analysis of observational studies directly comparing radical retropubic, laparoscopic, and robotic-assisted prostatectomy for the treatment of localized prostate cancer. The primary outcomes were operative blood loss, perioperative transfusion, surgical margin status, postoperative urinary incontinence, and postoperative erectile dysfunction. Based on established similarities in surgical principles, we combined laparoscopic and robotic-assisted data into a single group. We estimated standardized mean differences (SMD), risk ratios (RR), and risk differences (RD) using random effects models.ResultsNineteen studies (n = 3893 patients) met inclusion criteria for this analysis. Compared with those undergoing retropubic prostatectomy, patients undergoing laparoscopic or robotic-assisted prostatectomy experienced less operative blood loss (SMD -1.74, 95% confidence interval [CI] -1.74 to -1.49, P <0.001) and were 77% less likely to receive a perioperative transfusion (RR 0.23, 95% CI 0.11 to 0.49, P <0.001). There was no significant difference in overall risk of positive surgical margin (RR 0.88, 95% CI 0.74 to 1.06, P = 0.17). There were also no significant differences in 1-year urinary continence (P = 0.49) and 1-year erectile function (P = 0.09); however, these outcomes were measured using nonvalidated instruments.ConclusionsOur results suggest that, compared with retropubic prostatectomy, laparoscopic and robotic-assisted prostatectomy are associated with decreased operative blood loss, decreased risk of transfusion, and similar risk of positive surgical margin. Further comparative studies-using consistent, validated outcomes measures-are needed to further assess postoperative urinary continence and potency.

      Pubmed     Full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…