LAPAROSCOPIC VS OPEN BILATERAL NERVE-SPARING RADICAL PROSTATECTOMY AFTER TUR-P FOR INCIDENTAL PROSTATE CANCER: SURGICAL AND FUNCTIONAL OUTCOMES IN 120 PATIENTS

Aim of the study: To evaluate the surgical and functional outcomes in nerve-sparing laparoscopic radical prostatectomy (nsLRPT) and nerve-sparing retropubic radical prostatectomy (nsRRPT) after TUR-P for incidental prostate cancer. Material and methods: Between January 2006 and March 2009, 60 nsLRP and 60 nsRRP surgical procedures were performed at our clinic. Demographic data and perioperative and postoperative measurements and outcomes were compared. All surgical procedures were performed by two surgeons (F.G. laparoscopy, S.W. open surgery) who had completed at least 70 nsLRPTs and nsRRPTs and at least 200 laparoscopic and open radical prostatectomies each before the beginning of the study, thus reducing the learning-curve effect. Results: The mean operative time was 165±45 min for nsLRPT and 132.5±67.5 min for nsRRPT.The mean intraoperative blood loss was 500±250 ml and 675±325 ml in the nsLRPT and nsRRPT groups with a transfusion rate of 4% and 7%, respectively. The mean catheterization time was 8±1 days in the laparoscopic group and 11±2 days in the open group (p < 0.05). Each patient underwent a cystography on the 7th postoperative day to evaluate the urethral anastomosis for leakage. The length of hospitalization presents no statistical difference in the two groups (7 vs 9 days, p < 0.05). The laparoscopic group had a lower frequency of positive margins but without any statistically significant difference. At the 12th months, a complete continence was reported in 96% of patients who underwent a nsLRPT and in 90% of patients of the nsRRPT group. (p =0.03) Regarding sexual potency, 59% in the nsLRPT and 44% in the nsRRPT groups reported the ability to engage in sexual intercourse one year after surgery. Discussion: In recent years, LRP has been established as a safe and effective treatment for prostate cancer in specialized centres [7-13]. With better visualization of the anatomy and a relatively bloodless field, nsLRPT has the potential to provide good functional outcomes with equal oncologic effectiveness. Performing nervesparing radical prostatectomy in patients who previously had surgery for urinary obstruction can present some unexpected difficulties, requiring better surgical skills. To the best of our knowledge, the present study is the first to address the feasibility and the safety of nsLRPT in patients previously undergoing TUR-P. Conclusion: NsLRPT is a feasible procedure in patients diagnosed with prostate cancer who previously underwent TUR-P for BPH, although it may require highersurgical skills in comparing with patients who never underwent a prostate surgery. It provides satisfactory oncologic results, presenting superior functional outcomes with regard to urinary continence and sexual potency, when compared with nsRRPT after TUR-P.