Nerve sparing endoscopic extraperitoneal radical prostatectomy--effect of puboprostatic ligament preservation on early continence and positive margins.
BACKGROUND
A technical modification of nerve sparing endoscopic extraperitoneal radical prostatectomy (nsEERPE) with preservation of the puboprostatic ligaments is presented and compared to a previous technique.


METHODS
nsEERPE was performed in 100 men with clinically localized adenocarcinoma of the prostate from March 2004 through February 2005. Patients were divided into two groups: Group A included patients in whom a standard nsEERPE was performed (n=50), and group B included patients in whom a puboprostatic ligament sparing nsEERPE was performed (n=50). The postoperative follow-up was 2 weeks and 3 months evaluating preliminary effects on early continence and positive margins.


RESULTS
The early return to continence at 2 weeks postoperatively was achieved by 6 patients (12%) in group A, and 12 patients (24%) in group B. Three months after the procedure 24 (48%) and 38 (76%) patients were continent, in groups A and B respectively. Clinical outcome (early continence) was significantly better for Group B patients, at 2 weeks (chi-square test, p=0.0019) and at 3 months (chi-square test, p=0.0347) following surgery. No cases of complete or severe incontinence (more than 5 pads/day) were observed at 3 months after surgery, in either groups. Groups A and B did not exhibit significant differences regarding their histological status. In group A, positive margins were detected in 6.5% and 26.3% of patients with pT2 and pT3, respectively. In group B, positive margins were found in 3.2% and 15.8% of patients with pT2 and pT3, respectively


CONCLUSIONS
We propose the use of puboprostatic ligament-sparing nsEERPE as an intriguing method to ascertain recuperation of early continence after nerve sparing procedures, without hindering the final oncological outcome.
Stolzenburg
Jens-Uwe
JU
Department of Urology, University of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany, and Department of Urology, University Hospital of Patras, Greece. stolj@medizin.uni-leipzig.de
Liatsikos
Evangelos N
EN
Rabenalt
Robert
R
Do
Minh
M
Sakelaropoulos
George
G
Horn
Lars Christian
LC
Truss
Michael C
MC
D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery*; D000328:Adult; D000368:Aged; D004724:Endoscopy; D006801:Humans; D008022:Ligaments; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000294:innervation / Q000601:surgery; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D014549:Urinary Incontinence / Q000209:etiology / Q000517:prevention & control*