RECENT studies have highlighted the advantages of urethra-sparing robot-assisted simple prostatectomy (US-RASP) for patients with large-volume benign prostatic hyperplasia (BPH). BPH is a common condition affecting men over 50, with symptoms including urinary retention, recurrent infections, and reduced quality of life. Traditional surgical options, including open simple prostatectomy (OSP) and conventional RASP, are effective in relieving obstruction but often result in ejaculatory dysfunction, a significant concern for sexually active men.
Preserving Ejaculatory Function with US-RASP
US-RASP has emerged as a promising alternative that maintains sexual function while providing comparable outcomes in urinary symptom relief. Unlike conventional RASP, this technique preserves critical anatomical structures such as the prostatic urethra, bladder neck, and ejaculatory ducts, which helps maintain antegrade ejaculation. Studies report that one year postoperatively, up to 81% of patients retain normal ejaculatory function after US-RASP, compared with only 8–20% in standard RASP procedures. These findings highlight the procedure’s potential to enhance quality of life without compromising efficacy.
Comparable Voiding Outcomes and Safety
Beyond ejaculatory preservation, US-RASP demonstrates comparable improvements in voiding outcomes, including Qmax, post-void residual (PVR), and International Prostate Symptom Score (IPSS). Operative time, intraoperative blood loss, and perioperative complications are also similar to conventional RASP, supporting the safety and feasibility of this approach. Additionally, US-RASP often reduces hospital stay and catheterisation duration, offering faster recovery and lower healthcare resource utilisation.
Clinical Implications and Patient Selection
Although limitations exist, including the retrospective nature of most studies and technical complexity, US-RASP represents a significant advancement for large-volume BPH management. Its ability to balance effective obstruction relief with preservation of sexual function makes it particularly suitable for younger patients or those prioritising ejaculatory outcomes. Careful patient selection and surgical expertise are critical for optimising postoperative results and minimising complications.
In summary, US-RASP offers a safe, effective, and patient-focused approach to BPH surgery. By integrating advanced robotic technology, clinicians can achieve durable symptom control while significantly reducing the risk of postoperative ejaculatory dysfunction, making it a preferred option in appropriately selected cases.
Reference
Ying J et al. Efficacy and safety of urethral sparing versus other robot-assisted simple prostatectomy for large volume benign prostatic hyperplasia: a systematic review and meta-analysis. BMC Urol. 2025;25(1):251.
