Simple preoperative parameters to assess technical difficulty during a radical perineal prostatectomy.
OBJECTIVE
We aimed to propose a practical selection method predicting the easier radical perineal prostatectomy (RPP) cases before the operation.


METHODS
Fifty sequential RPP cases were divided into two groups according to the estimated difficulty of the operation (Group I: Easier, Group II: Difficult) which was assessed by using a RPP difficulty scale, constituted by three parameters (operation time, blood loss, and the judgment of the surgeon) each ranging between 1 and 3 points. As the localization parameters, skin-to-prostatic apex (SPAD) and skin-to-prostatic base (SPBD) distances and distance between bilateral ischial tuberosities (ITD) were measured. During suprapubic ultrasonography, a probe-divergence angle (PDA) and prostate volumes (PV) were recorded. These parameters were compared between the groups.


RESULTS
In Group I (n = 29) and Group II (n = 21), the difficulty scores were 4.37 (3-5) and 6.80 (6-9), respectively. Data of age, clinical stages, and findings of digital rectal examination were not different between groups. While SPBD, SPAD, and ITD values were found similar (p > 0.05), PDA and PV were significantly different. PDA was > 45 degree in 21 cases in Group I (72.4 %) and in 7 cases in Group II (33.3 %) (p = 0.011). The mean of PV was 37.4 (20-60) cc and 49.9 (30-75) cc in Group I and Group II, respectively (p = 0.001).


CONCLUSIONS
While planning RPP operations, by selecting the prostate cancer cases with a prostate of low volume and localized deeper in the pelvis during suprapubic ultrasonography, urologists may have a chance to perform this technique more easily during the learning period.
Kartal Egitim Arastırma Hastanesi, Uroloji Kliniği, Ana Bina, Kat 9, Cevizli, Kartal, Istanbul, Turkey. rahimhoruz@gmail.com
Rahim
R
Horuz
Cemal
C
Göktaş
Cihangir A
CA
Çetinel
Oktay
O
Akça
Önder
Ö
Cangüven
Cahit
C
Şahin
Alper
A
Kafkaslı
Selami
S
Albayrak
D000368:Aged; D001291:Attitude of Health Personnel; D016063:Blood Loss, Surgical; D006801:Humans; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D009929:Organ Size; D018579:Patient Selection; D010502:Perineum / Q000033:anatomy & histology* / Q000601:surgery; D057234:Preoperative Period; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology*; D011468:Prostatectomy / Q000193:education; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D014463:Ultrasonography