Presented by: Narmina Khanmammadova MD
University of California, Irvine, Department of Urology

Introduction

Hood technique was developed to improve postoperative functional outcomes following the robot-assisted radical prostatectomy (RARP). The main goal is to preserve periurethral structures that are essential for urinary continence: endopelvic fascia, puboprostatic ligaments, detrusor apron, some detrusor muscle, and anterior vessels. However, the working space for large prostates might be limited.  Here, we evaluate whether the hood technique is feasible for large prostates (>80 mL). 

Materials

Between March 2022 and March 2023, 121 patients underwent RARP with the hood technique. Twenty patients had prostate > 80 mL & 101 patients had prostate size < 80 mL. Preoperative and perioperative as well as postoperative characteristics were compared between the two groups. 

Urinary continence was defined as using no pads or 1 security pad. The ability to have a firm erection enough for penetration was described as the percentage fullness of erection reported by patients. 

Results

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Patients with prostate size > 80 g had significantly higher mean BMI (29.71 ± 5.68, p=0.018), higher Gleason scores on biopsy (p=0.004), and higher preoperative median AUA Symptom Scores (AUASS, 17 (8.5 - 22.5), p=0.020). There were no differences between the two groups in terms of estimated blood loss, overall operation time, console time, and dissection time. There was no need for early control of DVC or to convert to the conventional approach. Postoperative length of hospital stay, length of catheterization, readmission rates in 30 and 90 days, Gleason Score on surgical pathology, surgical margins, pathologic grades, postoperative complications, and PSA levels at 3 months were comparable between the two groups. No difference was observed in postoperative functional outcomes at 3 months including AUASS, continence rates, SHIM scores as well as percentage fullness of erection. Same-day discharge rates were comparable in both groups with prostate size >80 g and <80 g. (85%, 91.2%, p=0.396, respectively). 

Conclusion

Hood technique is feasible and safe in patients with large prostate volumes, without compromising early oncological outcomes and intermediate postoperative functional outcomes.  

Funding

No funding.

Co-Authors

Narmina Khanmammadova, MD
University of California, Irvine, Department of Urology

Mohammed Shahait, MBBS
Clemenceau Medical Center, Department of Surgery

Tuan Thanh Nguyen, MD, MSc
University of Medicine and Pharmacy at Ho Chi Minh City

Jacob Basilius, MD
University of California, Irvine, Department of Urology

Sohrab Naushad Ali, MD, MSc, FRCSC
University of California, Irvine, Department of Urology

Catherine Fung, NP
University of California, Irvine, Department of Urology

Caroline Nguyen, PA
University of California, Irvine, Department of Urology

David I. Lee, MD, FACS
University of California, Irvine, Department of Urology