Single-Port Radical Prostatectomy in Obese Patients: A Multi-Institutional Study Assessing Complications of Transperitoneal, Extraperitoneal, and Transvesical Approaches
Document Type
Conference Proceeding
Publication Date
5-2025
Publication Title
Journal of Urology
Abstract
INTRODUCTION AND OBJECTIVE: The optimal surgical approach for obese patients undergoing single-port robotic-assisted radical prostatectomy (SP-RALP) remains unclear. This study aimed to assess whether transperitoneal (TP), extraperitoneal (EP), or transvesical (TV) approaches affect perioperative outcomes in overweight and obese patients. METHODS: We retrospectively reviewed 1,255 patients who underwent SP-RALP from 2018 to 2023, categorized by BMI (overweight: BMI 25-29.9, Obesity Class I: BMI 30-34.9, Obesity Class II: ≥35) and surgical approach (TP, EP, TV). Perioperative complications were classified using the Clavien-Dindo system. Multivariable logistic regression and interaction analysis were performed to assess the impact of BMI and surgical approach on complication rates. LOWESS analysis was used to graphically represent the relationship between BMI and complication rates across surgical approaches. RESULTS: Of the 1,255 patients, 301 (24%) underwent TP, 702 (56%) EP, and 252 (20%) TV surgery. Patients were divided into three BMI categories: 269 (21%) were overweight, 609 (49%) were Obese I, and 377 (30%) were Obese II. Complications occurred in 171 patients (13.6%). Obese II patients had significantly higher complication rates (19.1%) compared to overweight (13.8%) and Obese I patients (10.2%). Although no baseline difference in complication rates was observed between surgical approaches (p=0.2), interaction term analyses demonstrated that obese II patients undergoing TP surgery had a higher complication risk (HR 4.3, p=0.001) compared to EP and TV approaches. LOWESS analysis (Figure 1) revealed that complication rates increased exponentially with higher BMI for TP, while remaining stable for EP and TV. CONCLUSIONS: Obese patients undergoing TP SP-RALP are at greater risk of complications compared to those undergoing EP or TV approaches. A tailored approach, favouring EP in high-risk obese patients, may reduce perioperative complications and improve surgical outcomes
Volume
213
Issue
5S
First Page
e785
Last Page
e785
Recommended Citation
Pellegrino AA, Mazzone E, Morgantini L, Moschovas M, Franco A, Soputro N, et al. [Nelson R]. Single-port radical prostatectomy in obese patients: a multi-institutional study assessing complications of transperitoneal, extraperitoneal, and transvesical approaches. J Urol. 2025 May;213(5S):e785. doi:10.1097/01.JU.0001109988.34650.0d.07
DOI
10.1097/01.JU.0001109988.34650.0d.07
Comments
American Urological Association Annual Meeting, April 26-29, 2025, Las Vegas, NV