Yiğit AKIN, Osman KÖSE, Sacit Nuri GÖRGEL, Serkan ÖZCAN, Yüksel YILMAZ, Ertan CAN, Batuhan ERGANİ, Ahmet Selçuk DİNDAR

Comparative outcomes of antegrade open radical prostatectomy with electrosurgical devices versus retrograde technique without devices

Aim: In this study we compared outcome of antegrade and retrograde radical prostatectomy with new homeostasis devices.Material and Methods: Present study includes retrograde view of prospective recorded data between January 2006 and January2016 in two different centers.The antegrade technique was applied to 67 cases with the Thunderbeat and the retrograde techniquewas performed as described by Reiner and Walsh before include with early division of the urethra.Demographic data,operative data(tPSA, ISUP, DM, etc.) and post-operative data (transfusion, hospitalization, surgical margin positivity, stenosis, etc.) were evaluated.Results: There was no difference in terms of demographic status.Incontinence resolved in 29patients in the antegrade group(%43)and resolved in 32patients in the retrograde group(%64) (p=0.012). Erectile dysfunction was observed in 28 patients in the firstgroup(41%) and in 18 patients in the second group(36%) (p=0,359).There was a statistical difference in terms of surgical marginpositivity in favor of the antegrade group for these results(p=0.003). Transfusion was required by 11 patients (16%) with the antegradetechnique and in 9 patients (18%) with the retrograde technique (p=0.055).There was no difference in terms of anastomosis stenosisand operation duration (p=0.357 and p=0.108).Conclusion: In our study,the antegrade method was shown to be an easier method with less hemorrhage,more reliable preservationof the neurovascular bundle and adding Thunderbeat to the procedure was found to add to the ease of surgery

PDF

___

1. Amling CL, Blute ML, Bergstralh EJ, et al. Long-term hazard of progression after radical prostatectomy for clinically localized prostate cancer: continued risk of biochemical failure after 5 years. J Urol 2000;164:101-5.
2. Baykara M, Akin Y, Sahiner IF, et al. Impact of Laparoscopic Experience on Open Radical Prostatectomy: A Pilot Study. Kuwait Med J 2016;48:25-9.
3. Rhee HK, Triaca V, Sorcini A, et al. Transperitoneal laparoscopic radical prostatectomy: descending technique. J Endourology. 2004;18:601-4.
4. Gozen AS, Akin Y. Are structured curriculums for laparoscopic training useful? A review of current literature. Curr Opin Urol 2015;25:163-7.
5. Walsh PC. Anatomic radical prostatectomy: evolution of the surgical technique. Urology 1998;160:2418-24.
6. Abbou C, Salomon L, Hoznek A, et al. Laparoscopic radical prostatectomy: preliminary results. Urology 2000;55:630-3.
7. Su L-M, Link RE, Bhayani SB, et al. Nerve-sparing laparoscopic radical prostatectomy: replicating the open surgical technique. Urology 2004;64:123-7.
8. Akin Y, Tunc L. Re: Is It Just Enough to Keep Long Membranous Urethra for Providing Early Continence After Robot-Assisted Laparoscopic Radical Prostatectomy? J Endourology 2016;30:359-60.
9. Delto JC, Wayne G, Yanes R, et al. Reducing robotic prostatectomy costs by minimizing instrumentation. J Endourol 2015;29:556-60.
10. Reiner WG, Walsh PC. An anatomical approach to the surgical management of the dorsal vein and Santorini’s plexus during radical retropubic surgery. J Urol 1979;121:198-200.
11. Epstein J, Eble J, Sauter G, et al. World Health Organization Classification of tumors: pathology and genetics of tumours of the urinary system and male genital organs. World Health Organization Classification of tumors: pathology and genetics of tumours of the urinary system and male genital organs. 2004.
12. Guillonneau B, Vallancien G. Laparoscopic radical prostatectomy: the Montsouris technique. J Urology 2000;163:1643-9.
13. Ko YH, Coelho RF, Sivaraman A, et al. Retrograde versus antegrade nerve sparing during robot-assisted radical prostatectomy: which is better for achieving early functional recovery? Eur Urol 2013;63:169-77.
14. Wei JT, Dunn RL, Marcovich R, et al. Prospective assessment of patient reported urinary continence after radical prostatectomy. J Urology 2000;164:744-8.
15. Tal R, Alphs HH, Krebs P, et al. Erectile function recovery rate after radical prostatectomy: a meta-analysis. J Sexual Med 2009;6:2538-46.
16. Carlsson S, Nilsson AE, Schumacher MC, et al. Surgery-related complications in 1253 robot-assisted and 485 open retropubic radical prostatectomies at the Karolinska University Hospital, Sweden. Urology 2010;75:1092-7.
17. Kundu SD, Roehl KA, Eggener SE, et al. Potency, continence and complications in 3,477 consecutive radical retropubic prostatectomies. J Urol 2004;172:2227-31.
18. Kao TC, Cruess DF, Garner D, et al. Multicenter patient self-reporting questionnaire on impotence, incontinence and stricture after radical prostatectomy. J Urol 2000;163:858-64.