The impact of prostate size on single-port robot-assisted radical prostatectomy surgical outcomes.

Abstract

To evaluate the effect of prostate size on surgical outcomes in single-port robot-assisted radical prostatectomy (SP-RARP). We conducted a multicentre analysis of patients undergoing SP-RARP between 2018 and 2024. Our primary endpoint was to assess the impact of prostate size on SP-RARP surgical outcomes, including operating time, estimated blood loss (EBL), nerve-sparing status, margin status, and intra-/postoperative complications. Logistic regression models assessed the independent impact of prostate size (calculated at final pathology) on these outcomes. A total of 343 patients were included; the median (interquartile range) prostate size was 46 (37-52) g. Of these, 114 patients had a prostate size of ≤40 g, 175 of 41-69 g, and 54 of ≥70 g. Larger prostates were associated with significantly prolonged operating time (265 vs 301 vs 306 min, P < 0.001), increased EBL (100 vs 100 vs 150 mL, P = 0.012), and lower nerve-sparing rates (79% vs 64% vs 44%, P < 0.001). Non-focal positive margins occurred in 23% of cases, with no significant differences across size groups (P = 0.6), nor for intraoperative (P = 0.2) or for postoperative complications (P > 0.9) rates between prostate size groups. In multivariable logistic regression, prostate size remained an independent predictor of prolonged operating time above median (P = 0.012), increased EBL above median (P = 0.007), and lower nerve-sparing (P = 0.002). No significant association was found with margin status (P = 0.092) or postoperative complications (P > 0.9). Prostate size impacts intraoperative complexity in SP-RARP but does not increase complication or margin rates. These findings support the feasibility and safety of SP-RARP across a broad range of prostate sizes, consistent with trends reported for multiport RARP.