title: Impact of cosmetic result on selection of surgical treatment in patients with localized prostate cancer.
abstract: OBJECTIVE
  To analyze the effect of cosmetic outcome as an isolated variable in patients undergoing surgical treatment based on the incision used in the 3 variants of radical prostatectomy: open (infraumbilical incision and Pfannestiel incision) and laparoscopic, or robotic (6 ports) surgery.
  
  
  METHODS
  612 male patients 40 to 70 years of age with a negative history of prostate disease were invited to participate. Each patient was evaluated by questionnaire accompanied by a set of 6 photographs showing the cosmetic appearance of the 3 approaches, with and without undergarments. Participants ranked the approaches according to preference, on the basis of cosmesis. We also recorded demographic variables: age, body mass index, marital status, education level, and physical activity.
  
  
  RESULTS
  Of the 577 patients who completed the questionnaries, the 6-port minimally invasive approach represents the option preferred by 52% of the participants, followed by the Pfannestiel incision (46%), and the infraumbilical incision (11%), respectively. The univariate and multivariate analyses did not show statistically significant differences when comparing the approach preferred by the patients and the sub-analyses for demographic variables, except for patients who exercised who preferred the Pfannestiel incision (58%) instead of minimally invasive approach (42%) with statistically significant differences.
  
  
  CONCLUSIONS
  The minimally invasive approach was the approach of choice for the majority of patients in the treatment of prostate cancer. The Pfannestiel incision represents an acceptable alternative. More research and investment may be necesary to improve cosmetic outcomes.
authors.affiliation: Urology Department, Hospital Universitario de Fuenlabrada, Madrid, Spain.
authors.forename: María Alejandra Egui
authors.initials: MA
authors.lastname: Rojo
authors.affiliation: Urology Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain.
authors.forename: Juan Ignacio
authors.initials: JI
authors.lastname: Martinez-Salamanca
authors.affiliation: Urology Department, Hospital Universitario Infanta Leonor, Madrid, Spain.
authors.forename: Mario Alvarez
authors.initials: MA
authors.lastname: Maestro
authors.affiliation: Urology Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain.
authors.forename: Ignacio Sola
authors.initials: IS
authors.lastname: Galarza
authors.affiliation: Urology Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain.
authors.forename: Joaquin Carballido
authors.initials: JC
authors.lastname: Rodriguez
mesh_terms: D000328:Adult; D000368:Aged; D006801:Humans; D010535:Laparoscopy / Q000941:ethics* / Q000379:methods; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011468:Prostatectomy / Q000941:ethics*; D011471:Prostatic Neoplasms / Q000523:psychology* / Q000601:surgery*; D012371:Robotics / Q000941:ethics*; D011795:Surveys and Questionnaires
keywords: cosmesis; prostate cancer; radical prostatectomy