Background: We evaluated the impact of prostate size on perioperative and pathological outcome in patients undergoing robot-assisted extraperitoneal prostatectomy.
Methods: 250 patients underwent daVinci robot-assisted extraperitoneal radical prostatectomy for clinically localized prostate cancer at our institution from July 2003 - March 2005. Perioperative and pathological data were obtained and patients with prostates >75 grams (g) and <75 g were compared.
Results: The median prostate weight was 85 (75-135) and 47 (21-74) grams in the two groups. A total of 28 patients were in the > 75 g group and 222 patients were in the <75 g group. Patients with larger prostates were older with a median age of 63 (55-76) versus 60 (42-73) years (p<0.01) and had higher median preoperative PSA levels at 7.4 (0.7-24) versus 5.45 (0.6-26) (p<0.01). There was no significant difference in the median total operative time (233 minutes (m) and 224 m) or the estimated blood loss (250 ml. and 150 ml.) between the two groups. Postoperative pathological stage and positive surgical margin rates were not significantly different between the two groups. There was an increase in postoperative urinary retention and urinary tract infection in the large prostate group with otherwise overall similar complication rates.
Conclusion: Robot-assisted extraperitoneal prostatectomy can be carried out safely in patients with large prostates. There is no significant difference in operative parameters such as blood loss or operative time for these patients. A large prostate may increase the likelihood of postoperative retention and could suggest a subset of patients that may require longer postoperative catheterization.

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