Radical retropubic versus laparoscopic prostatectomy: a prospective comparison of functional outcome

Anastasiadis, Aristotelis G.; Salomon, Laurent; Katz, Ran; Hoznek, Andràs; Chopin, Dominique; Abbou, Clément‐Claude

doi:10.1016/s0090-4295(03)00352-2

Cited by 174 publications

(98 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This outcome is in agreement with Anastasiadis' findings, which suggest that there are no significant differences between open retropubic and transperitoneal laparoscopic RP regarding functional outcome. 23 As shown in several other studies, patients who had undergone nerve-sparing RP have a greater chance to regain sexual function than patients who had undergone non-nerve-sparing RP. 9,10,24 However, even 1 year after nerve-sparing RP, 66% of patients had a severe form of ED, 27% of patients had regained at least some degree of EF and only 7% of patients had regained full EF.…”

Section: Discussionmentioning

confidence: 78%

Erectile dysfunction after radical prostatectomy: the impact of nerve-sparing status and surgical approach

et al. 2012

View full text Add to dashboard Cite

The core question of the study was whether the nerve-sparing status and surgical approach affected the patients' sexual life in the first year after surgery. In addition, determinants of erectile function (EF) and the extent of sexual activity were investigated. We conducted a multicentric, longitudinal study in seven German hospitals before, 3, 6 and 12 months after radical prostatectomy (RP). A total of 329 patients were asked to self-assess the symptoms associated with erectile dysfunction (ED). These symptoms were assessed using the International Index of Erectile Function and EORTC QLQ-PR25 questionnaires. A multiple regression model was used to test the influence of clinical, socio-demographic and quality-of-life-associated variables on the patients' EF 1 year after RP. Before surgery, 39% of patients had a severe ED (complete impotence). At 3, 6 and 12 months after surgery, it was 80, 79 and 71%, respectively. Although the surgical approach had no significant effect on EF, patients who had undergone nerve-sparing surgery had significantly lower ED rates. Nevertheless, 1 year after RP, 66% of these patients had severe ED. Age, nerve-sparing status and the burden of urinary symptoms had the greatest impact on the patients' EF. Regardless of nerve-sparing status and surgical approach, postsurgical improvement of EF does not mean a full convalescence of presurgical EF. Instead, it may rather reduce the degree of postsurgical ED in time. Consequently, urologists should disclose to the patient that ED is a likely side effect of RP. INTRODUCTIONIn many Western countries, prostate cancer has become the most frequently diagnosed cancer in the male population. In Germany, the current incidence is about 60 000 cases per year. 1 Since the introduction of prostate cancer screening, prostate cancer-specific incidence rates have doubled from approx. 50 per 100 000 in 1980 to approx. 100 in 2006. 2 Moreover, there has been a trend towards earlier-stage disease at presentation. 3,4 If detected in a localised state, the most common treatment for prostate cancer is radical prostatectomy (RP). RP can be performed in several ways. The classical approach is open retropubic prostatectomy. Furthermore, RP can be performed in a minimalinvasive laparoscopic way. Both surgical approaches have excellent survival outcomes. In Germany, the 5-year relative survival rate for prostate cancer is between 83 and 94%. 1 However, there are also strong side effects of RP, for example, erectile dysfunction (ED). 5 Depending on the surgical technique, patient age and other sociodemographic and clinical factors, ED rates differ a lot. Even 1 year after RP, ED occurs in about 12--83% of patients. 5--8 The current study is the first prospective multicentre study to compare the functional results of patients who underwent either radical retropubic prostatectomy (RRPE) or endoscopic extraperitoneal radical prostatectomy (EERPE). In this paper, we report data related to the patients' sexual life before (t baseline ), 3 months (t 3m ), 6 months (t 6...

show abstract

Section: Discussionmentioning

confidence: 78%

Erectile dysfunction after radical prostatectomy: the impact of nerve-sparing status and surgical approach

et al. 2012

View full text Add to dashboard Cite

show abstract

“…Nevertheless, the 72% potency rate following bilateral NS LRP in our study population compares favorably to patient-reported potency of 53-67% following bilateral NS LRP in other reported series. 13,35,36 Several groups have directly compared LRP to RRP and found a similar recovery of sexual function between the two techniques. 13 29% (30) 59% (19) 57% (14) 42% (67) 53% (54) 61% ( (31) 57% (60) 33% (78) 41% (22) 29% (42) 20% ( 64% (27) 40% (57) 64% (44) 52% (14) 35% (40) 41% ( Use of a validated quality of life questionnaire A Wagner et al control.…”

Section: Discussionmentioning

confidence: 98%

“…12,13,31,32 Recovery of sexual funcUse of a validated quality of life questionnaire A Wagner et al tion following LRP has also been reported to be comparable to open series. 13,27,29,[33][34][35][36] Unfortunately, these studies have used varying methods of evaluating pre-and postoperative potency and none utilize the global sexual domain scores included in EPIC. Nevertheless, the 72% potency rate following bilateral NS LRP in our study population compares favorably to patient-reported potency of 53-67% following bilateral NS LRP in other reported series.…”

Section: Discussionmentioning

confidence: 99%

Use of a validated quality of life questionnaire to assess sexual function following laparoscopic radical prostatectomy

et al. 2005

View full text Add to dashboard Cite

Wide variations exist in the methods for evaluating potency following radical prostatectomy. We describe our technique of laparoscopic radical prostatectomy (LRP), present our methods for assessing the return of potency following LRP, and discuss the relevant literature. Sexual function was assessed pre-and postoperatively using the Expanded Prostate Cancer Index Composite questionnaire (EPIC). Sexual function subscale scores (SFSS) were reported as a percentage of preoperative baseline sexual function. The EPIC was also used for single-question assessment of successful intercourse. We also reviewed the literature on prospective health-related quality of life results following LRP and open radical retropubic prostatectomy. Only patients reporting preoperative intercourse were analyzed. Of these, 72 and 35% undergoing bilateral and unilateral nerve sparing (NS) reported postoperative intercourse at 12 months (P ¼ 0.01). Mean SFSS at 12 months was 61 and 57% of baseline after bilateral and unilateral NS, respectively (P ¼ 0.71). Following NS procedures, 74% of patients p58 years of age and 41% of patients 458 years of age reported successful intercourse at 12 months (P ¼ 0.015). Mean SFSS was 64 and 52% of baseline function (P ¼ 0.249) at 12 months for patients p58 and 458 years of age, respectively. In patients o58 years of age who underwent bilateral NS surgery, 82% reported intercourse at 12 months. In conclusion, return of sexual function following NS LRP in our experience is comparable to reports from centers of excellence in open prostatectomy. Standardizing data collection using validated quality of life instruments can provide both surgeon and patient with a realistic forecast of relative return to normal sexual function following prostatectomy.

show abstract

“…In incontinent patients, even the severity of incontinence seems to be similar after the two procedures (48). The Montsouris group reported on a series of 255 patients with 12-months follow-up after LRP that 209 patients (82.3%) were pad free, 31 (12%) needed one pad a day, and 15 patients (5.9%) had urinary incontinence requiring more than two pads a day (49).…”

Section: Continencementioning

confidence: 99%

Laparoscopic radical prostatectomy: a review

et al. 2009

View full text Add to dashboard Cite

Introduction:We offer an overview of the intra-, peri-and postoperative outcomes of laparoscopic radical prostatectomy (LRP) with the endpoint to evaluate potential advantages of this approach. Materials and Methods:We conducted an extensive Medline literature search (search terms "laparoscopic radical prostatectomy" and "radical prostatectomy") from 1990 until 2007. Only full-length English language articles identified during this search were considered for this analysis. A preference was given to the articles with large series with more than 100 patients. All pertinent articles concerning localized prostate cancer were reviewed. Conclusion: Pure LRP has shown to be feasible and reproducible but it is difficult to learn. Potential advantages over open surgery have to be confirmed by longer-term follow-up and adequately designed clinical studies.

show abstract

Radical retropubic versus laparoscopic prostatectomy: a prospective comparison of functional outcome

Cited by 174 publications

References 25 publications

Erectile dysfunction after radical prostatectomy: the impact of nerve-sparing status and surgical approach

Erectile dysfunction after radical prostatectomy: the impact of nerve-sparing status and surgical approach

Use of a validated quality of life questionnaire to assess sexual function following laparoscopic radical prostatectomy

Laparoscopic radical prostatectomy: a review

Contact Info

Product

Resources

About