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Early Postoperative Urinary and Sexual Functional Outcomes: Comparison of Extraperitoneal and Transperitoneal Laparoscopic Radical Prostatectomy
Edward M Schaeffer1, Richard E Link2, Lynda Z Mettee*1, Adam Levinson1, Christian P Pavlovich1
1Johns Hopkins University, Baltimore, MD;2Baylor College of Medicine, Houston, TX
Introduction: Extraperitoneal laparoscopic radical prostatectomy (eLRP) closely recapitulates open surgical principles, but is associated with a smaller working space. We assessed whether this approach may impair postoperative functional outcomes.
Methods: 272 consecutive LRP were performed by one surgeon (CPP) well into his learning curve, the initial cases transperitoneally (tLRP) and the latter cases primarily eLRP. The anastomoses were interrupted (2-0 Vicryl). Patients completed 0, 3, and 6 mo. postop expanded index composite (EPIC) questionnaires. The Urinary Incontinence (UIN) subscale and a question detailing pad usage, and the Sexual Function subscale (SFSS) and a single question regarding intercourse were used. Postoperative subscale data are presented as a % of patients’ preop baselines.
Results: The tLRP (N=212) and eLRP (N=60) cohorts were similar in age, BMI, prostate size, IPSS, UIN and SFSS. Postop UIN trended better in the eLRP group (3 mo: 47.1% tLRP vs 56.3% eLRP, p=0.05; 6 mo: 65.3 vs 72.8, p=0.29). More men were continent (0-1 ppd) after eLRP (47% tLRP vs 61% eLRP at 3 mo., p=0.1; 74% tLRP vs 84% eLRP at 6 mo., p<0.05). Similar numbers of men were engaging in intercourse 3 mo. (27% tLRP vs 30% eLRP) and 6 mo. (39% tLRP vs 41% e LRP) after surgery, (p>0.05), and SFSS did not differ between tLRP and eLRP (3 mo: 35.5% vs 35.7%; 6 mo: 42.8% vs 37%, respectively).
Conclusions: The extraperitoneal LRP approach is associated with an earlier return to urinary continence and had no adverse impact on early potency outcomes.
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