ArticleWorld journal of urology2026
Suprapubic transvesical adenoma resection versus robot-assisted simple prostatectomy for prostates ≥ 80 mL: an exploratory early-outcome comparison.
Article in World journal of urology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeRobot-assisted simple prostatectomy (RASP) is an established but resource-intensive option for large benign prostatic enlargement. Suprapubic transvesical adenoma resection of the prostate (STAR-P) is a recently described bipolar endoscopic technique that resects the adenoma through a suprapubic access, avoiding transurethral instrumentation. We compared their early outcomes in prostates ≥ 80 mL.
methodsIn an exploratory, non-randomized, two-centre analysis of prospectively maintained data, we compared baseline, perioperative and one-month outcomes, changes from baseline, and a composite endpoint [Trifecta: maximum urinary flow rate (Qmax) > 15 mL/s, International Prostate Symptom Score (IPSS) < 8, no postoperative complications], with a logistic model adjusting for age and baseline IPSS.
resultsSixty-one patients were included (26 STAR-P, 35 RASP). STAR-P patients were older (69.5 vs. 64.0 years; p = 0.019), with higher baseline IPSS (29.5 vs. 25.0; p = 0.005) and more often a prominent median lobe (84.6% vs. 48.6%; p = 0.006). Catheterization was shorter after STAR-P (3 vs. 7 days; p < 0.001), whereas postoperative Qmax was higher after RASP (24.0 vs. 13.8 mL/s; p = 0.002). STAR-P showed a greater IPSS reduction and a smaller haemoglobin decrease; ΔQmax did not differ (p = 0.100). No major bleeding event occurred after STAR-P versus nine (26%) after RASP. Trifecta did not differ (42% vs. 54%; p = 0.440), but the study had only 15% power for this comparison.
conclusionSTAR-P and RASP showed distinct early profiles rather than superiority of either technique: STAR-P favoured shorter catheterization, lower symptoms and less bleeding, whereas RASP produced stronger early flow improvement. Whether avoiding the urethra reduces urethral morbidity remains an untested hypothesis.
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