Differences among patients undergoing perineal or retropubic radical prostatectomy in pain and perioperative variables: a prospective study

Abstract

level, Gleason score and clinical stage. Pain after RP was evaluated using numerical and oral scales, and by morphine intake delivered by a patient-controlled analgesia pump. Perioperative features assessed prospectively were operating time, intraoperative bleeding, time to diet, time to ambulation, hospital stay and complications. Immediate oncological results were assessed based on histopathological evaluation, e.g. Gleason score, tumour volume, prostate volume, surgical margins and final pathological stage. RESULTSBetween October 2004 and October 2007 80 patients were accrued (mean age 63 years, range 42-80). The groups were similar for preoperative data, but group R1 had larger prostates ( P = 0.001). For postoperative pain, group R1 had a significantly greater intensity of pain, based on the visual analogue scales, and greater morphine intake during the first 24 h than the other three groups. Groups P1 and P2 had significantly less bleeding (511 and 612 mL) than groups R1 and R2 (926 and 1165 mL; P < 0.001), regardless of both prostate size and anaesthesia. Complications occurred in 27.5% and 25% (not significant) of patients after PRP and RRP, respectively. There were no differences in positive surgical margin rate and histopathological evaluation among the groups. CONCLUSIONSPatients who had RRP with general anaesthesia had a greater intensity of pain and higher morphine intake than the other groups. Men who had PRP had significantly less bleeding and shorter hospital stay than those having RRP.

Transversus abdominis plane block or subcutaneous wound infiltration after open radical prostatectomy: a randomized study

“…In addition, all patients received gabapentin 600 mg pre‐operatively. Pain (VAS) scores in our control group (receiving the basic analgesic regimen with placebo‐TAP and placebo‐wound infiltration) were below 30 mm at all time points at rest, but 30–40 mm during mobilization in the first four post‐operative hours, which is comparable with findings from other studies of ORRP . It is well known that adequate assay sensitivity in acute pain trials may only be achieved when patients are experiencing at least ‘moderate pain’, which has been estimated to correspond to 30 mm on a VAS scale .…”

The effects of retropubic and perineal radical prostatectomy techniques on postoperative urinary continence after surgery: Results of 196 patients

“…Because of widespread use of PSA, predictability of rates of lymph node metastasis using various nomograms including Partin's, questionable necessity, and value of PLND in low-risk prostate cancer, lesser pain, and shorter hospital stay in RPP in comparison to RRP, RRP has rapidly dropped down the scale of desirability. [10,11] Thanks to comparable oncological, and functional outcomes between RPP, and RRP, minimally invasive, and cost-effective characteristics of RPP, as asserted in many current updated articles, RRP has been withdrawn from the therapeutic armamentorium of localized PCa. [12] In a review article, Coelho et al [13] analyzed the results of the studies related to retropubic, laparoscopic, and robot-assisted radical prostatectomies performed in high-volume centers where patients who didn't use daily urinary pads or employed only one urinary pad a day for the purpose of control of dryness during one-year follow-up period were considered to be continent, and authors reported continence rates for RRP, LRP, and RYRP, as 79, 84.8, and 92%, respectively.…”

Radical Prostatectomy in the Robotic Era. Comparison of Three Different Methods: Retropubic, Robotic and Perineal

“…Schmeller and Paiva reported that no analgesics were needed starting from post-operative day 2. We believe that it does not lead to common pain issues experienced after a robotic prostatectomy (such as delays in return of the bowel movements) due to the small incision size, that the location of incision is not directly involved in mobilization, and the lack of abdominal gas insufflation (78,79).…”