Recovery of urinary function after robotic-assisted laparoscopic prostatectomy versus radical perineal prostatectomy for early-stage prostate cancer



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.

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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


  1. 1.

    Weyrauch HM (1959) Surgery of the prostate. WB Saunders CO, Philadelphia

    Google Scholar 

  2. 2.

    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

    Article  Google Scholar 

  3. 3.

    Weldon VE, Tavel FR (1988) Potency-sparing radical perineal prostatectomy: anatomy, surgical technique and initial results. J Urol 140(3):559–562

    CAS  Article  Google Scholar 

  4. 4.

    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

    Article  Google Scholar 

  5. 5.

    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

    Article  Google Scholar 

  6. 6.

    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

    PubMed  PubMed Central  Google Scholar 

  7. 7.

    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

    CAS  Article  Google Scholar 

  8. 8.

    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

    Google Scholar 

  9. 9.

    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

    Article  Google Scholar 

  10. 10.

    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

    CAS  Article  Google Scholar 

  11. 11.

    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

    Article  Google Scholar 

  12. 12.

    Comploj E, Palermo S, Trenti E et al (2011) Radical perineal prostatectomy: an outdated procedure? Int J Surg 9(5):400–403

    Article  Google Scholar 

  13. 13.

    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

    Article  Google Scholar 

  14. 14.

    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

    Article  Google Scholar 

Download references


This study was funded by a philanthropic grant from the Ministrelli Program for Urology Research and Education.

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Correspondence to Laura N. Nguyen.

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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.

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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.

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Informed consent was obtained from all individual participants included in the study.

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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).

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  • Prostatectomy
  • Urinary incontinence
  • Patient outcome assessment
  • Surveys and questionnaires