A comparison of the relative merits of radical perineal and radical retropubic prostatectomy

Abstract

Objective To compare the outcome, advantages and disadvantages of retropubic and perineal approach to radical prostatectomy, as performed by one surgeon. Patients and methods This unrandomized study included 138 patients who underwent either radical retropubic (RRP) or radical perineal prostatectomy (RPP), based on the speci®c conditions or the patient's choice; 79 patients (mean age 64.6 years) underwent RPP and 59 (mean age 61.7 years) RRP. Outcome measures included estimated blood loss, the incidence of blood transfusions, positive margins and complications, operative duration, analgesic use, days in hospital and quality of life. Results There was no difference in operative duration, and the incidence of positive margins or complications between the groups. The mean estimated blood loss in the RPP and RRP groups was 415 and 1138 mL, respectively. The RPP group stayed a mean of 2.2 days less in hospital and took 2.8 days less to regain a full diet than the RRP group; the RPP group needed 1.7 days before using oral analgesics and the RRP group 3.8 days. Of patients in both groups, 85% were pad-free at one year and their overall quality of life was similar. Conclusions The results of RRP and RPP are comparable; the advantages of the perineal approach include minimal blood loss, low-intensity postoperative nursing care, low analgesic use and earlier discharge from hospital.

Comparative analysis of radical prostatectomy techniques using perineal or suprapubic approach in the treatment of localized prostate cancer

“…The occurrence of urinary fistula has been reported in all studies and for both techniques. Gillitzer and Thuroff (8) described 3.5% of primary fistulas in a series employing both techniques, which is consistent with the findings of Sullivan et al (11) . Treatment of the fistula is initially based on the use of an indwelling bladder catheter.…”

“…Harris (9) reported urinary retention in 2% of patients submitted to both surgical techniques. Sullivan et al (11) registered 19% ofurinary retention and stenosis of the urethrovesical anastomosis in a similar study.…”

“…Both Sullivan et al (11) and Gillitzer et al (8) found a 5% incidence of surgical wound infection due to hematoma or other reasons, in both techniques. However, Lance et al (4) verified higher incidence of infection as to perineal approach, amounting to 2% as compared to suprapubic access.…”

“…Rectal lesion may evolve to fistula in up to 3.6% of cases, requiring colostomy to deviate intestinal transit. Sullivan et al (11) reported 5% of rectal lesions using the perineal technique. Doblet et al (5) , studying 24 patients operated by perineal technique, described 3 cases of rectal lesion, and only one case in a group of 16 patients operated by the suprapubic technique.…”

Experience with radical perineal prostatectomy in the treatment of localized prostate cancer

“…Renaissance RPP demonstrates proven long-term cancer control of RRP with low morbidity, rapid convalescence (therefore, a high patient acceptance), and lower operative times and lower hospital costs than with RRP or LRP [Sullivan et al 2000;Harris, 2007;Comploj et al 2011;Harris, 2003;Guillonneau et al 2003;Lotan et al 2004;Silverstein et al 2004]. …”