Median Lobe in Robot-Assisted Radical Prostatectomy: Evaluation and Management

UroToday –

The surgical margins were similar between the two groups. No significant difference was found in the postoperative urinary bother score or the interval to social or perfect continence between the two groups.

The results of this study have shown that the presence of a median lobe does not alter the outcomes in patients who undergo robot-assisted prostatectomy.

The median lobe can be a scary finding for the novice robotic surgeon. My team at NBI has developed several techniques to handle median lobes while preserving as much bladder as possible. Below is a video showing one of our techniques:

I have changed by preoperative management to include a cystoscopy about 1 year ago on all patients to assess for prostate shape. I can now predict these in all patients.

I am a little surprised that these patients did not have differences except more needed bladder neck repairs. I think these patients are more likely to have bladder symptoms since most have obstruction and over active bladders to start with. In my series, they usually get their catheters out in 5 days instead of 3, and I warn them of expecting more urinary problems in the short term than others.

Delivery of the Median Lobe: A novel way to perform one of the most difficult parts of the dvP

This is my first technique that I will be adding to a new section of the blog.
After watching many videos and trying different ways to approach an intravesical median lobe, I found a new way to take care of it.
The following video was uploaded to google video and shows the dissection of a median lobe.

In simple terms: The bladder holds the urine and then the urine passes through the prostate on its way out. The prostate needs to be removed completely in prostate cancer surgery. The prostate is separated from the bladder routinely during the operation.
The median lobe is the part of the prostate that sometimes pushes into the bladder. This is the main reason why some urologists elect to place scopes into peoples bladders prior to surgery. This is one of the most difficult parts of the operation for beginners and experienced surgeons. The video shows the prostate (yellow) being separated from the bladder (green). The stitch is placed into part of the prostate to lift it off of the bladder.
Instruments used: PK dissector (bipolar), hot shears (monopolar- setting coag only 30), 2 needle drivers
Suture: 2’0 vicryl on an SH needle. (I have used 0’vicryl on a CT-1 for larger median lobes)
Color scheme- Yellow- Prostate; Green bladder and bladder opening; Orange arrrow- foley

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