Open Radical Retropubic Prostatectomy as a Saviour in the Era of Robotics- A Single Surgeon Experience

Abstract

Background Outcome of its safety, perioperative outcomes, functional outcomes, oncologic outcomes in open radical retropubic prostatectomy for organ confined prostate cancers in the era of robotic surgery. Methods A prospective study of radical retropubic prostatectomy performed at SKIMS between 2013 and 2020 was conducted. Work up of the patients in the study (n=42) included age, comorbidities, serum prostate-specific antigen levels, digital rectal examination, MPMRI prostate, prostatic biopsy (Gleasons score), bone scan and optional PSMA PET scan. Intraoperative findings and pathological variables -T stage, nodal status, any extraprostatic extension, apical margin, bladder neck, seminal vesical invasion, lymph nodal status, post operative BCR need for any hormonal and salvage radiotherapy were recorded. On follow up particular emphasis was given on trifecta as cancer control, urinary continence, erectile function and overall satisfaction. Results Out of 42 patients 7 patients were continent at 1 month follow up, 27 at 3 months, 39 at 6 months and 41 at 12 months. One patient continued to be incontinent at 1 year. Out of 16 patients with nerve sparing RPP 10 patients were potent with PD 5 inhibitor assistance at 6 months and all at 1 year ( Potency was defined as the ability to have erections adequate enough for penetration more than 50% of the times). Three patients had Biochemical recurrence on follow up and both were subjected to hormonal and salvage radiotherapy. Thirty nine patients were disease free at last follow up. Conclusions Radical prostatectomy is the standard of care for organ confined prostatic carcinoma. Aim of the procedure is trifecta as cancer control, urinary continence, and erectile function. Minimally invasive techniques as Robotics should not be a limiting factor especially when affordablity and non availability is concern.