Robotic-assisted laparoscopic prostatectomy (RALP) has largely replaced open radical prostatectomy in many centers. Radical perineal prostatectomy (RPP) is another less invasive approach that has not been widely adopted. RPP offers excellent exposure of the urinary sphincter and bladder neck that may provide good urinary function outcomes. We evaluate urinary function after RALP and RPP.
Retrospective review of a prospective radical prostatectomy database was performed. Urinary modules from the Expanded Prostate Cancer Index Composite—Urinary Function (EPIC-UF) questionnaire were used to determine urinary symptoms at baseline and at 6, 12, 18, and 24 months after surgery.
753 men underwent RALP (n = 623) or RPP (n = 130). Of these, 558 had complete data and were included in our study (RALP: n = 458, RPP: n = 100). A higher number of patients undergoing RALP than RPP had pelvic lymph node dissection (20.2% vs. 0%, p < 0.0001) and cavernosal neurovascular bundle sparing (79.2% vs. 68.4%, p < 0.0001). 558 patients had complete EPIC-UF data. Overall urinary recovery was greater for RALP than RPP at 6 months (p = 0.028). Urinary incontinence and function were also more improved after RALP compared to RPP at 6 months (p = 0.021, p = 0.006). However, no differences in overall, urinary incontinence, or urinary function scores were seen at 12, 18, or 24 months. There was no difference between groups in urinary bother or irritative/obstructive symptoms at any time point.
RALP had more rapid recovery of urinary function at 6 months vs. RPP; at 12–24 months, however, RALP and RPP had similar urinary function recovery in all urinary subdomains.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Body mass index
Expanded Prostate Cancer Index Composite
Expanded Prostate Cancer Index Composite—Short Form
Expanded Prostate Cancer Index Composite—Urinary Function
Robotic-assisted laparoscopic prostatectomy
Radical perineal prostatectomy
Weyrauch HM (1959) Surgery of the prostate. WB Saunders CO, Philadelphia
Young HH (1945) The Cure of Cancer of the Prostate by Radical Perineal Prostatectomy (prostato-seminal Vesiculectomy): History, Literature and Statistics of Young’s Peration 1 1Read by title at annual meeting, American Urological Association, St. Louis, Mo., June 20, 1944 and amplified. J Urol 53(1):188–252
Weldon VE, Tavel FR (1988) Potency-sparing radical perineal prostatectomy: anatomy, surgical technique and initial results. J Urol 140(3):559–562
Prasad SM, Gu X, Lavelle R, Lipsitz SR, Hu JC (2011) Comparative effectiveness of perineal versus retropubic and minimally invasive radical prostatectomy. J Urol 185(1):111–115
Wronski S (2012) Radical perineal prostatectomy—the contemporary resurgence of a genuinely minimally invasive procedure: procedure outline. Comparison of the advantages, disadvantages, and outcomes of different surgical techniques of treating organ-confined prostate cancer (PCa). A literature review with special focus on perineal prostatectomy. Cent Eur J Urol 65(4):188–194
Leung AC, Melman A (2005) Radical perineal prostatectomy: a more optimal treatment approach than laparoscopic radical prostatectomy in obese patients? Rev Urol 7(1):48–52
Wei JT, Dunn RL, Litwin MS, Sandler HM, Sanda MG (2000) Development and validation of the expanded prostate cancer index composite (EPIC) for comprehensive assessment of health-related quality of life in men with prostate cancer. Urology 56(6):899–905
Diokno AC, Killinger KA, Ibrahim IA, Petzel KJ (2007) Establishing a prostatectomy outcomes database for clinical practice improvement, research, and education: a community hospital experience. J Clin Outcomes Manag 14(10):541–546
Skolarus TA, Dunn RL, Sanda MG et al (2015) Minimally important difference for the expanded prostate cancer index composite short form. Urology 85(1):101–105
Daugherty M, Chelluri R, Bratslavsky G, Byler T (2017) Are we underestimating the rates of incontinence after prostate cancer treatment? Results from NHANES. Int Urol Nephrol 49(10):1715–1721
Demirkesen O, Onal B, Tunc B et al (2007) Assessment of the continence status and patients’ satisfaction after retropubic radical prostatectomy: a questionnaire based study. Int Urol Nephrol 39(2):531–536
Comploj E, Palermo S, Trenti E et al (2011) Radical perineal prostatectomy: an outdated procedure? Int J Surg 9(5):400–403
Young MD, Weizer AZ, Silverstein AD et al (2003) Urinary continence and quality of life in the first year after radical perineal prostatectomy. J Urol 170(6 Pt 1):2374–2378
Nguyen LN, Head L, Witiuk K et al (2017) The risks and benefits of cavernous neurovascular bundle sparing during radical prostatectomy: a systematic review and meta-analysis. J Urol 198(4):760–769
This study was funded by a philanthropic grant from the Ministrelli Program for Urology Research and Education.
Conflict of interest
Drs. Jafri and Nguyen declare that they have no conflicts of interest to disclose. Dr. Sirls reports personal fees from Johnson & Johnson, for whom he is a consultant, and research grants from StimGuard.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
About this article
Cite this article
Jafri, S.M., Nguyen, L.N. & Sirls, L.T. Recovery of urinary function after robotic-assisted laparoscopic prostatectomy versus radical perineal prostatectomy for early-stage prostate cancer. Int Urol Nephrol 50, 2187–2191 (2018). https://doi.org/10.1007/s11255-018-2013-8
- Urinary incontinence
- Patient outcome assessment
- Surveys and questionnaires