Seminal vesicle‐sparing perineal radical prostatectomy improves early functional results in patients with low‐risk prostate cancer

Abstract

antigen (PSA) level of ≤ 10 ng/mL, a Gleason sum of ≤ 7 and a prostate volume of ≤ 50 mL. This group was randomly divided in those having SV-RPP (147 men) and a classical RPP (171); men in the third group with adverse factors were offered a classical RRP (190). The main endpoint of the trial was the early continence rate at 4 weeks after surgery. RESULTSThe oncological outcome of patients treated with SV-RPP was no different from that of RPP or RRP. Continence rates (0-1 pad/day) at 4 weeks and 12 months after SV-RPP were 61.7% and 96.3%, respectively, and significantly higher than with RPP ( P < 0.023) and RRP ( P < 0.005). The transfusion rates (3.4%), anastomotic leaks (6.6%) and mean operative duration (90 min) were significantly lower. CONCLUSIONSSV-RPP is a better technique in reducing complications during and after surgery for selected patients. Leaving the SV in place did not increase the short-term PSA relapse rates. As the operation was significantly faster and with better early recovery, SV-RPP might be justified if the long-term oncological data confirm the efficacy of the approach. KEYWORDSprostate cancer, radical prostatectomy, perineal, nerve-sparing, seminal vesiclesparing Study Type -Therapy (RCT) Level of Evidence 1b OBJECTIVETo report a new and improved seminal vesicle-sparing (SV) technique of radical perineal prostatectomy (RPP) as an option for patients with localized prostate cancer, which is currently competing with the retropubic RP (RRP), endoscopic and robotic approaches.

Is it Necessary to Remove the Seminal Vesicles Completely at Radical Prostatectomy? Decision Curve Analysis of European Society of Urologic Oncology Criteria

“…There are isolated reports from small non-randomized series of patients undergoing SV -sparing, and authors have typically reported better than expected outcomes for urinary and erectile function. [11-14] More recently, however, Albers et al have reported the results of a trial of a SV-sparing strategy [15]. Patients were deemed eligible for SV-sparing using more liberal criteria than the ESUO: PSA of 10 ng / ml or less; biopsy Gleason score of 7 or less and total prostate volume ≤ 50 ml.…”

Prediction of sexual function after radical prostatectomy

“…Moreover, in properly selected patients, some authors advocate an advantage in favor of a partial excision of the seminal vesicles to reduce the risk of damaging the pelvic plexus and to minimize injury to the cavernosal innervation 27 However, such an approach remains controversial because of the lack of long-term data assessing disease recurrence and survival. Moreover, recent data have questioned the applicability of previously validated criteria for selecting patients who are suitable for a seminal vesicle-sparing approach.…”

Comparison of Three Different Tools for Prediction of Seminal Vesicle Invasion at Radical Prostatectomy

“…The tip of the seminal vesicles is close to the arterial supply of the bladder base and to the proximal neurovascular bundles. Some investigators have suggested that sparing the tip of these structures would decrease erectile and urinary dysfunction [6–9]. Three small retrospective studies have demonstrated improved functional outcomes following seminal vesicle-sparing surgery [6–8].…”