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

Objectives: To determine whether the presence of a median lobe can be predicted preoperatively and whether its presence affects postoperative urinary function and immediate pathologic outcomes after robot-assisted radical prostatectomy. Methods: A retrospective review of 345 consecutive patients who underwent robot-assisted radical prostatectomy at our institution from August 2004 to March 2007 was performed. Of these 345 patients, 29 (8%) were found at surgery to have a median lobe. All 29 patients were compared with 29 consecutive patients without a median lobe in terms of preoperative parameters, intraoperative parameters, and the pathologic and clinical outcomes. Results: Of the preoperative parameters, the two groups were similar in age, race, preoperative Gleason score, and urinary bother score. Of the 10 patients with a median lobe who had undergone preoperative computed tomography scans, 7 (70%) had a visible median lobe. The presence of a median lobe did not increase the operative time required for bladder neck dissection or anastomosis (including reconstruction). Of the 29 patients with a median lobe, 16 (55%) required bladder neck reconstruction compared with 1 (4%) without a median lobe. Postoperatively, the two groups had similar Gleason score, but patients with a median lobe had larger prostates (60 cm³ versus 26 cm³; P = 0.003). 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. Conclusions: 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.