[Retropubic and perineal approach: plea for perineal radical prostatectomy].
OBJECTIVE
Two surgical approaches are proposed for radical prostatectomy: the retropubic route and the perineal route. We compared the surgical, oncological and functional aspects of these two approaches and present arguments suggesting that the perineal approach is the preferred approach for radical prostatectomy.


METHODS
55 retropubic radical prostatectomies were retrospectively compared to 55 perineal radical prostatectomies and performed between March 1992 to December 1995. The clinical TNM, preoperative PSA, results of 6 systematized intrarectal biopsies, operating time, intraoperative bleeding, number of patients transfused and number of packed cell units per patient transfused, medical and surgical complications, catheterization time and length of hospital stay, incidence of urethrovesical anastomosis leak and stenosis, analysis of the prostatectomy specimen, course of PSA, continence and erection were studied.


RESULTS
Statistically significant differences were observed for the retropubic and perineal approaches, respectively: preoperative PSA (24 vs 15 ng/mL), intraoperative bleeding (2664 vs 1071 mL), number of patients transfused (91% vs 28%), number of packed cell units per patient transfused (3.9 vs 2.7), medical and surgical complications (56.9 vs 29.1%), anastomotic leak (24.1 vs 7.2%), anastomotic stenosis (31.5 vs 1.8%), duration of catheterization (18 vs 13 days) and length of hospital stay (14 vs 8 days). At 2 years, PSA remained less than 0.5 ng/mL in both groups.


CONCLUSIONS
Even taking the learning period into account, the perineal approach provides the same results as the retropubic approach in terms of functional and oncological parameters, with a simpler postoperative course for patient.
Salomon
L
L
Service d'Urologie, Hôpital Henri Mondor, Créteil, France.
Colombel
M
M
Patard
J J
JJ
Contremoulins
I
I
Bellot
J
J
Lefrére-Belda
M A
MA
Gasman
D
D
Chopin
D
D
Abbou
C C
CC
D000368:Aged; D003627:Data Interpretation, Statistical; D005069:Evaluation Studies as Topic; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery; D012189:Retrospective Studies
D017430:Prostate-Specific Antigen
Voies rétropubienne et périnéale: plaidoyer pour la prostatectomie radicale par voie périnéale.