title: [RALP: comparison of the oncological and functional outcomes of the intrafascial and the interfascial approaches].
abstract: BACKGROUND
  Due to its technical ease and greater precision Robotic Assisted Laparoscopic radical Prostatectomy (RALP) allows a better preservation of the neurovascular bundles, thereby improving functional outcomes. The intrafascial dissection has been proposed to allow a more complete preservation of these bundles. However, this technique harbors a high rate of positive surgical margins, justifying another trend: the interfascial approach. To date, there are still few publications directly comparing these 2 techniques and our study is the first to offer a 2-year follow-up.
  
  
  METHODS
  Our study focused on a two-hundred patients population divided into two consecutive groups. All the patients were continent preoperatively and had a satisfactory IIEF5 score: (1) Group 1 consisted of 100 patients who underwent RALP with the intrafascial approach. They had a mean age of 60.3 years (45-70). The majority of cancers were of the low or moderate risk group of d'Amico. The mean PSA was 7.43ng/ml. Seventy-five patients had a pT2, 24 a pT3 and one patient had a pT4. (2) Group 2 included 100 patients who underwent RALP with the interfascial technique. Patients had a mean age of 61.6±5.96 years (45-72), and their cancers were mostly of the low or moderate risk groups of d'Amico. The mean PSA was 6.3ng/ml. Seventy-four patients had a pT2, 22 a pT3a, and 4 had a pT3b. All patients were evaluated after one and two years of follow-up.
  
  
  RESULTS
  Rates of positive surgical margins were 45% and 19% respectively for groups 1 and 2 (P<0.0001). The rates of biochemical failure (PSA>0.2ng/ml) at 2 years were 10% and 3%, respectively for groups 1 and 2 (P=0.0447). At 2 years, 2 patients in group 1 and one patient in group 2 were using 2 or more urinary pads. Erection with or without oral medication was maintained in 65 (65%) and 31 (31%) patients respectively for groups 1 and 2 at one year. At 2 years 86 and 65 patients were having spontaneous erection, respectively in groups 1 and 2 (P=0.0006). In addition, 65 and 55 patients were also capable of sexual penetration, respectively in groups 1 and 2 (P=0.0045).
  
  
  CONCLUSIONS
  The intrafascial approach exposed to a very high rate of positive surgical margins while offering only a little benefit in the erectile function preservation at 2 years compared to the interfascial variant. In our series, we did not notice any significant difference between the two techniques concerning the urinary continence.
  
  
  METHODS
  5.
authors.affiliation: Service d'urologie du CHU de Nice, hôpital l'Archet 2, 151, route St-Antoine de Ginestière, Nice, France. Electronic address: sabdal67@yahoo.com.
authors.forename: S A
authors.initials: SA
authors.lastname: Al-Mamari
authors.affiliation: Institut Arnault-Tzanck, 165, avenue Maurice-Donat, Saint-Laurent-du-Var, France.
authors.forename: H
authors.initials: H
authors.lastname: Quintens
authors.affiliation: Service d'urologie du CHU de Nice, hôpital l'Archet 2, 151, route St-Antoine de Ginestière, Nice, France.
authors.forename: N
authors.initials: N
authors.lastname: Mentine
authors.affiliation: 2, rue Philibert-Delorme, Cannes, France.
authors.forename: C
authors.initials: C
authors.lastname: Burté
authors.affiliation: Service de pathologie, DIAG, 24, rue Anatole de Monzie, Nice, France.
authors.forename: N
authors.initials: N
authors.lastname: Rouyer
authors.affiliation: Clinique Saint-Georges, 2, avenue de Rimiez, Nice, France.
authors.forename: G
authors.initials: G
authors.lastname: Jacob
authors.affiliation: Service d'urologie du CHU de Nice, hôpital l'Archet 2, 151, route St-Antoine de Ginestière, Nice, France.
authors.forename: J
authors.initials: J
authors.lastname: Amiel
mesh_terms: D000368:Aged; D005500:Follow-Up Studies; D006801:Humans; D016496:Incontinence Pads / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010410:Penile Erection; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000097:blood / Q000150:complications / Q000601:surgery*; D065287:Robotic Surgical Procedures / Q000379:methods*; D014549:Urinary Incontinence / Q000209:etiology
chemical_list: D017430:Prostate-Specific Antigen
keywords: Biochemical failure; Chirurgie robotique; Dysfonction érectile; Erectile dysfunction; Incontinence urinaire; Marges chirurgicales; Prostatectomie totale; Robotic Assisted Laparoscopic radical Prostatectomy (RALP); Récidive biochimique; Surgical margins; Urinary incontinence