Perineal radical prostatectomy in the age of laparoscopy
With the advent of laparoscopic lymphadenectomy, attention has been focussed again to the perineal approach for cancer of the prostate. The high rate of postoperative impotence and the abdominal incision required had made radical perineal prostatectomy unpopular. From August 1990 to July 1991, 76 patients with localized prostate cancer were surgically treated at the University of St. Louis. These patients were divided into three groups; group A comprised 26 patients who were submitted to laparoscopic lymphadenectomy and radical perineal prostatectomy, group B comprised patients treated by laparoscopic lymphadenectomy and radical retropubic prostatectomy, and group C or controls underwent open lymphadenectomy and radical retropubic prostatectomy. Fifty-three patients were sexually potent preoperatively but only 20 (7 from group A, 5 from group B and 8 from group C) were considered for preservation of the neurovascular bands. All the patients were followed for a minimum of one year. Comparison of these three groups revealed significant differences for perioperative bleeding and postoperative hospital stay in favor of Group A. The overall stress incontinence rate was 5.3% and the complications ranged from 4.1% for group C and 29.1% for group B. The postoperative sexual potency ranged from 57% for group A to 75% for group C, the differences not being statistically significant. Radical perineal prostatectomy is as valid as radical retropubic prostatectomy for localized prostatic cancer and has the advantages of less bleeding and a faster recovery, particularly if combined with laparoscopic lymphadenectomy.