Radical perineal prostatectomy: An outdated procedure?

Abstract

Objectives: Radical perineal prostatectomy (RPP) is an alternative to the retropubic, laparoscopic or robotic prostatectomy approaches. This study reports the experience with RPP of a single surgeon at a single institution; the technical aspects, oncological outcome, and complications, such as urinary incontinence and erectile dysfunction, were investigated.

Methods: A total of 212 consecutive patients with a mean age of 63 (range 45-74) years and clinically localised prostate cancer were monitored. Between January 2001 and December 2010, all patients underwent RPP that was performed by a single experienced surgeon at one institution. All data were introduced into a database focussing on the intra-operative and post-operative complications, continence rate, potency and oncological outcome.

Results: The mean follow-up was 48 (6-117) months. Intra-operative complications, both early and late, occurred in 19% of the patients. The average length of in-hospital stay was 9 (3-45) days, and the mean period of time spent with a urethral catheter in place was 9 (4-45) days. The continence rate was 81%, and the potency rate, without any pharmacological aid, was 27%. The overall PSA-free survival rate was 86%. There was one cancer-specific death.

Conclusion: On the basis of our prospective data, we conclude that RPP provides satisfactory oncological results with an acceptable outcome in terms of quality of life. RPP can be considered to be mini-invasive and achieves results that are equivalent to those of the alternative surgical approaches.