title: Open complete intrafascial nerve-sparing retropubic radical prostatectomy: technique and initial experience.
abstract: OBJECTIVE
  To report our refinement of open intrafascial retropubic radical prostatectomy (OIF-RP) and 1-year follow-up results.
  
  
  METHODS
  OIF-RP was performed in 231 cases of clinically localized Prostate cancer in a prospective study from January 2007 to December 2009. Inclusion criteria were good potency (IIEF-5 score ≥ 15), Gleason score ≤ 6, prostate-specific antigen (PSA) ≤ 10, and clinical T1-2 tumors. Endopelvic fascia was not incised, and the prostate capsule was freed laterally from surrounding fasciae and dorsally from Denonvillier's fascia, keeping all periprostatic fasciae/nerves intact. Functional outcomes were followed at 3 and 12 months (3 M and 12 M). Continence defined as complete (no pads), grade I (1-2 pads/day) and grade II (>2 pads/day).
  
  
  RESULTS
  Median age was 63.3 years, body mass index 25.6, and PSA 5.4 ng/mL. Median operating time was 65 minutes (range 50-250), blood loss was 150 mL (range 50-1000), preoperative IIEF-score was 23 (range 15-25). Pathologic stage was pT2 (91%) and pT3 (9%). Gleason score was ≤ 6 (73%) and ≥ 7 (27%). Positive margins were 10% (pT2) and 65% (pT3). There were no postoperative complications/reinterventions. At 3 M, 60% of patients had full continence, and 86% had full continence at 12 M (≤ 60 years, 64% and 95% after 3 M and 12 M, respectively). At 3 M and 12 M, median IIEF-score was 14 (range 0-25) and 19 (range 0-25), respectively. Baseline IIEF-score was reached by 50% (3 M) and 78% (12 M) (P<.001). IIEF-score was inversely correlated to patients' age (≤ 60 years 92%, 60-69 years 77%, ≥ 70 years 60%).
  
  
  CONCLUSIONS
  OIF-RP follows rationales of radical prostatectomy and might be considered for selected patients. Preserving all periprostatic fasciae/nerves recuperates early continence and maintains potency without affecting oncological outcomes.
authors.affiliation: Department of Urology, Grosshadern University Hospital, Ludwig-Maximilians-University-Munich, Munich, Germany. wael.khoder@med.uni-muenchen.de
authors.forename: Wael Y
authors.initials: WY
authors.lastname: Khoder
authors.forename: Boris
authors.initials: B
authors.lastname: Schlenker
authors.forename: Raphaela
authors.initials: R
authors.lastname: Waidelich
authors.forename: Alexander
authors.initials: A
authors.lastname: Buchner
authors.forename: Nicole
authors.initials: N
authors.lastname: Kellhammer
authors.forename: Christian G
authors.initials: CG
authors.lastname: Stief
authors.forename: Armin J
authors.initials: AJ
authors.lastname: Becker
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004210:Dissection; D006801:Humans; D016496:Incontinence Pads / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D011467:Prostate / Q000294:innervation; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D020127:Recovery of Function; D014549:Urinary Incontinence / Q000453:epidemiology