Initial Experiences of Retropubic Radical Prostatectomy Including Antegrade Nerve Sparing, Continuous Anastomosis, and Preservation of Endopelvic Fascia

Abstract

Purpose: We compared retropubic radical prostatectomy (RRP) with various laparoscopic radical prostatectomy procedures with RRP as previous performed in our institution. Materials and Methods: Demographics, perioperative and functional outcomes of 78 patients that underwent modified RRP (mRP; N=53) or established RRP (eRP; N=25) at our institution from January 2013 to December 2018 were evaluated retrospectively. Postoperative incontinence and erectile dysfunction are involved functional outcomes. During the modified procedure, with preserving endopelvic fascia, the prostate was dissected in an antegrade fashion with bilateral nerve sparing, and then urethrovesical anastomosis was performed with continuous suture. Results: The mean age was older in mRP (68.7±5.3 years) than mRP (65.9±5.0 years) and mean prostate volume was larger in mRP (40.1±18.6 mL) than eRP (30.4±14.0 mL). Mean operative time was longer in eRP (227.0±111.1 minutes) than mRP (154.6±31.6 minutes) and estimated blood loss and complicate rate were similar in 2 groups. The pathologic stage was all T2 stage in eRP, however, in mRP T2 stage was 31 and T3 stage was 22. The pathologic Gleason score was higher in mRP than eRP (p=0.001). Positive surgical margin was significantly higher in mRP, however, biochemical recurrence was insignificantly higher in mRP. Incontinence rates at 3 and 12 months after eRP decreased from 96.0% to 28.0% and after mRP decreased from 49.1% to 7.5%. Overall postoperative potency rate at 12 months was significant different in eRP and mRP groups (8.0% and 34.0%). Conclusions: The mRP was found to have favorable functional outcome and short operative time. This technique might be adopted by inexperienced urologic surgeons as a standard procedure.