Department of Urology, The Royal Surrey County Hospital , Guildford, Surrey, UK.
The Prostate Clinic, Old Basing, United Kingdom.
To investigate the results of laparoscopic radical prostatectomy (LRP) beyond the learning and discovery curves of 700 patients previously reported by the authors for potency.
Five hundred consecutive patients underwent LRP during a 28-month period with a minimum follow-up of 12 months. Median age (with range)=61.0 (33-76) years; prostate-specific antigen level=7.0 (1-37); biopsy Gleason sum=7 (4-10). Clinical stage was T(1) in 41.0%, T(2) in 54.2%, and T(3) in 4.8%. Nerve preservation (NP) was performed bilaterally in 57.9%, unilaterally in 15.3%, and on neither side in 26.8%.
Median operative time was 157 (91-331) minutes, with no conversions or intraoperative blood transfusions; 0.4% of patients received a transfusion postoperatively, and 4.2% had complications. There were no rectal injuries. The overall positive margin rate was 13.0% and correlated with pathologic parameters. At a minimum of 1 year follow-up (mean=13.5 (12-36) mos), overall survival was 100%, and biochemical disease-free survival was 98.8%. The pad-free rate was 97.4%. Potency (International Index of Erectile Function-5 score ≥17) at a mean follow-up of 13.5 months in previously potent men in their 4th, 5th, 6th, and 7th decades after bilateral NP was 100.0%, 91.8%, 82.9%, and 60.0% and after unilateral NP was 100%, 66.7%, 50.1%, and 0.0%. Overall potency after bilateral neurovascular bundle NVB preservation was 86.9%.
LRP is capable of matching or exceeding the best results for open radical prostatectomy and robot-assisted radical prostatectomy when performed by an experienced surgeon in a high-volume setting. These results suggest that the method used to perform radical prostatectomy is a less important determinant of success than surgical experience.
Written by:
Eden CG, Arora A, Hutton A. Are you the author?
Reference: J Endourol. 2011 Apr 21. Epub ahead of print.
doi: 10.1089/end.2010.0451
PubMed Abstract
PMID: 21510804
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