January 11th, 2012

Robotic Surgery May Not Reduce Common Prostatectomy Side Effects


Among men who undergo radical prostatectomy for the treatment of early-stage prostate cancer, robotic-assisted laparoscopic surgery may not result in better urinary or sexual function than traditional, open surgery. These results were published in the Journal of Clinical Oncology.

Treatment options for early-stage prostate cancer include surgery, radiation therapy, and active surveillance (close observation but no treatment until the cancer shows signs of worsening).

Radical prostatectomy refers to the surgical removal of the entire prostate and some surrounding tissue. Prostatectomy may be performed using traditional open surgery, in which the surgeon makes a single, long incision, or through a laparoscopic procedure (sometimes called minimally invasive surgery), in which several small incisions are made. During laparoscopy, the surgeon inserts a small video camera through one of the incisions in order to see inside the abdomen. In a variant of laparoscopic surgery known as robotic-assisted laparoscopic surgery, the surgeon sits at a console near the operating table and performs the surgery by controlling robotic arms that hold the surgical instruments.

Use of robotic-assisted prostatectomy has increased rapidly in the United States, but relatively few studies have compared the procedure with open surgery. To evaluate whether the two procedures produce different rates of urinary incontinence or sexual dysfunction, researchers evaluated Medicare claims data and surveyed men who had undergone a prostatectomy. Completed surveys were obtained from 406 men who had undergone robotic-assisted prostatectomy and 220 men who had undergone open surgery.

  • Overall, 31% of the men reported moderate or big problems with incontinence, and 88% of the men reported moderate or big problems with sexual function.
  • The frequency of sexual problems and incontinence did not vary significantly by type of surgery.
  • A limitation of the study is the lack of information about patients’ preoperative urinary or sexual functioning. The study also focused on operations performed in 2008, when some surgeons had less experience with robotic-assisted prostatectomy.

Although not definitive, the results of this study suggest that both approaches to prostatectomy (open surgery and robotic-assisted laparoscopic surgery) produce high rates of urinary incontinence and sexual dysfunction in Medicare-age men.

Reference: Barry MJ, Gallagher PM, Skinner JS, Fowler FJ. Adverse effects of robotic-assisted laparoscopic versus open retropubic radical prostatectomy among a nationwide random sample of Medicare-age men. Journal of Clinical Oncology. Early online publication January 3, 2011.

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Tags: Early Stage I-II (A-B) Prostate Cancer, News, Prostate Cancer, Uncategorized, Urology