Comparison of the advantages of radical perineal prostatectomy and radical retropubic prostatectomy

Introduction: Many urologists have been preferring radical retropubic prostatectomy (RRP) to radical perineal prostatectomy in order to facilitate pelvic lymphadenectomy. Recent studies concerning preoperative PSA and Gleason score with regard to negative lymphatic node status have given surgeons an opportunity to select those cases where lymphadenectomy can be avoided. This has revived interest in the perineal approach. We compared the perineal with the retropubic approach in radical prostatectomies performed by an urologist. Method: Radical prostatectomy was performed either perineally or retropubically in a total of 138 patients. Results were grouped according to the following parameters: estimated blood loss (EBL), frequency of blood transfusions, positive status of wound edges, complications, time required for surgery, requires quantity of analgesics, duration of hospital stay and "quality of life". Results: 79 patients (average age 64, [62a]) were subjected to RPP, whereas 59 patients (average age 61, [70a]) underwent RRP. There were no differences in respect of time require for surgery, positive status of wound edges or complications, Average blood loss was 415 mi in the RPP group, whereas it was 1138 ml in the RRP group. Hospital stay of RPP group patients was 2.2 days shorter than with RRP group patients. Postoperative days until normal diet were 2.8 days less with the RPP group than with the RRP group. Oral analgesics could be administered to RPP group patients after 1.67 days and to RRP group patients after 3.75 days. After one year, 85% of the patients in both groups were no longer in need of pads,The overall "Quality of life" was comparable. Conclusions: Perineal prostatectomy yields results that are comparable with those obtained with retropubic prostatectomy. The advantages of RPP include minimal blood loos, less need for postoperative care, lower consumption of analgesics and a shorter hospitalisation time.