Surgery

Contemporary appraisal of radical perineal prostatectomy

Journal of Urology 173(6):1863-1870, June 2005
Daniel M Janoff and Raul O Parra

Study purpose: Minimally invasive surgery uses the latest technology to perform complicated operations through small incisions, eliminating scalpels and sutures that require longer recovery time. The field’s successes are renewing interest in radical perineal prostatectomy (RPP), one of the first “minimal-access” surgical procedures. Radical perineal prostatectomy is surgery that removes a man’s cancerous prostate through a small incision in the perineum, the area of the body between the genitals and the anus where the prostate is closest to the skin. This study surveys recent medical literature to examine how RPP is currently being used to combat “localized” prostate cancer that hasn’t spread from where it first appeared. The study also reviews the anatomy of the perineum and the techniques used in the operation.

Findings: The authors’ review shows that RPP remains an effective treatment for localized prostate cancer. It has results similar to a more commonly done surgery called radical retropubic prostatectomy (RRP), where the prostate is removed via an abdominal incision. In comparison to the retropubic technique, the authors discovered that patients who had RPP had less discomfort after the surgery, regained control of their bowels more rapidly, and needed fewer blood transfusions. Rates of incontinence and erectile dysfunction were similar to those experienced after conventional surgery.

Conclusions: The study emphasizes that the perineal approach to prostatectomy (RPP) has fewer deaths and complications than standard retropubic surgery (RRP). It is also not as technically challenging as a new technique using laparoscopy (microsurgery that requires a half-inch incision and complex technology). The authors conclude that there is still a role for radical perineal prostatectomy in the treatment of cancer localized in the prostate gland.

Note: RPP is not suitable for everyone requiring a prostatectomy. The authors highlight the need for physicians to carefully choose candidates based on the extent and seriousness of their cancer.

Laparoscopic Radical Prostatectomy

Journal of Urology 173(4):1072-1079, April 2005
Edouard J Trabulsi and Bertrand Guillonneau

Study purpose: Laparoscopic radical prostatectomy is innovative microsurgery that removes a cancerous prostate gland with the aid of a laparoscope (a thin, lighted tube). The use of laparoscopic surgery to remove the prostate is now becoming widespread, with several techniques used. This study from France reviews the English-language medical literature on laparoscopic radical prostatectomy up to June 2004.

Study description: Only studies involving 50 or more patients were reviewed.

Findings: The literature review done by the authors indicates that laparoscopy lessens complications during and after the prostate’s removal, especially when done by an experienced surgeon. Men’s ability to control urination and perform sexually after the operation was also encouraging.

Conclusions: Overall results from laparoscopic prostatectomy are about the same as those of more conventional surgery. Research is needed to firmly establish laparoscopy as an alternative.

Note: Mainly preliminary studies have been published to date. The incompleteness of the research makes it hard to evaluate how good laparoscopic radical prostatectomy is at controlling prostate cancer.