Transvesical <i>vs</i> Transcapsular Robot-Assisted Multiport Simple Prostatectomy: A Comparative Analysis of Perioperative Outcomes

<b><i>Purpose:</i></b> Robotic surgery belongs to the standard therapies for patients with benign prostate hyperplasia (BPH) with large prostates (over 80 g). To evaluate postoperative outcomes and complications of transvesical <i>vs</i> transcapsular multiport robot-assisted simple prostatectomy (RASP) for BPH. <b><i>Methods:</i></b> Between September 2019 and November 2024, 100 consecutive patients were included and divided into group 1, <i>n</i> = 40 transvesical, and group 2, <i>n</i> = 60 transcapsular. Outcomes included operative time, catheter duration, hospital stay, and complications (Clavien-Dindo). <b><i>Results:</i></b> Patients in the transvesical group had higher baseline symptom bother (International Prostate Symptom Score: 27 <i>vs</i> 18; quality of life: 5.5 <i>vs</i> 3.5). Transcapsular RASP demonstrated shorter console time (71 <i>vs</i> 91 minutes), reduced catheter duration (4.3 <i>vs</i> 6.7 days, <i>p</i> = 0.001), and shorter hospitalization (5 <i>vs</i> 6 days, <i>p</i> = 0.02). Major complications were recorded more frequently in the transvesical group (12.5% <i>vs</i> 3.3%, <i>p</i> = 0.04). Minor complications and readmissions were similar among the study groups (<i>p</i> = 0.3 and 0.8). <b><i>Conclusion:</i></b> Transcapsular RASP may lead to quicker recovery, whereas transvesical techniques are more appropriate for complex cases involving bladder issues. The choice of method depends on the surgeon's preference, but further prospective studies are necessary to gather more information.