[Critical comparative analysis between open, laparoscopic and robotic radical prostatectomy: urinary continence and sexual function (part II)]

Abstract

Objectives: Radical prostatectomy is worldwide accepted as treatment for clinically localized prostate cancer. Its oncological results are excellent, so nowadays the functional outcomes: continence and potency, have become essential factors when evaluating the results. Open radical prostatectomy (ORP) is the gold standard against the new techniques, Laparoscopic (LRP) and robotic (RRP) must be compared. A systematic review of the literature is done to evaluate functional outcomes between the three approaches.

Methods: Systematic review in the databases: PubMed; EMBASE; Cochrane; SCOPUS; Science Citation Index for: "radical retropubic prostatectomy", "open radical prostatectomy"; "laparoscopic prostatectomy"; "laparoscopic radical prostatectomy"; "robotic prostatectomy"; "robotic radical prostatectomy and functional assessment"; "continence"; "urinary function"; "incontinence"; "erectile function"; 'sexual function"; "quality of life"; "functional assessment"; "minimally invasive treatment was performed".

Results: The lack of randomized trials for this issue forces us to evaluate the functional results comparing the most important series of each approach, so the value of the results are very limited. Accepting 0 pads per day as continence definition and evaluated 12 months following surgery, the continence rates for each approach ORP, LRP and RRP are respectively: 8 1% (60-93%); 87% (82-95%) and 91% (84-98%). For erectile function admitting the capability for intercourse as potency definition, with or without the use of oral drugs and evaluated 12 months following surgery; the potency rates for each approach are: 68% (62-75%), 69% (52-78%) y 60% (20-97%).

Conclusions: Due the lack of randomized trials, we have to evaluate the most important contemporaneous series. The lack of homogeneity in evaluating and reporting results is evident in the urological community. With the limitations of the data available it seems to exist no differences between the three groups for functional outcomes. It is mandatory to develop randomized trials and achieve a consensus for the criteria at the time of evaluating the functional outcomes.