Authors contributions: Surgery and data acquisition was equally done by all authors. The text was written by Nikolaus Schmeller and corrected by the other authors.
Original Article: Clinical Investigation
Head-to-head comparison of retropubic, perineal and laparoscopic radical prostatectomy
Article first published online: 28 FEB 2007
International Journal of Urology
Volume 14, Issue 5, pages 402–405, May 2007
How to Cite
Schmeller, N., Keller, H. and Janetschek, G. (2007), Head-to-head comparison of retropubic, perineal and laparoscopic radical prostatectomy. International Journal of Urology, 14: 402–405. doi: 10.1111/j.1442-2042.2006.01727.x
- Issue published online: 15 MAY 2007
- Article first published online: 28 FEB 2007
- Received 8 September 2006; accepted 6 November 2006.
- urinary incontinence;
- urogenital surgical procedures
Objective: As more patients are diagnosed with prostate cancer at an early stage, it is becoming increasingly important to refine the technique of surgical excision. For this purpose we have generated objective data comparing three different surgical approaches used by three experienced surgeons.
Methods: We prospectively compared three contemporary personal series of 50 consecutive radical prostatectomy (RP) patients. The health-related quality of life was evaluated preoperatively and in months 1, 3, 6, 12 and 24.
Results: Considering in turn the patients undergoing retropubic, perineal and laparoscopic RP, the median procedure time was 2 h and 27 min, 1 h and 50 min and 4 h, with a transfusion rate of 2, 0 and 8%, respectively. In the perineal group there were more wound infections. Median catheter drainage was 7, 10 and 7 days and zero, 13 and one patients needed reinsertion of a catheter. Early continence varied considerably, with 57.4, 11.4 and 6.3% of patients pad-free after 1 month, but there were no differences in social continence (zero or one pad) with 97.8, 97.8 and 91.9% after 2 years. The Litwin score for incontinence (preoperative minus postoperative) was −24, −41 and −63% after 1 month and −13, +3 and −29% after 2 years. Twenty-nine, five and 15 patients had a preoperative five-item version of International Index of Erectile Function (IIEF-5) score of ≥17 points and a nerve-sparing procedure. After 2 years, 48.1, 0 and 0% had an IIEF-5 score of ≥17 points without the use of phosphodiesterase type 5 (PDE-5) inhibitors, but when including patients using inhibitors there were no significant differences.
Conclusions: A comparison of morbidity, short-term convalescence and long-term side-effects of different surgical techniques is strongly biased by both the preoperative status of patients and the skill of the surgeons. Overall, we found some differences in the short-term results (e.g. early continence) and comparable long-term results.