Prostatectomy Approaches Have Similar Continence Impact

By David Douglas

NEW YORK FEB 14, 2007 (Reuters Health) - Open radical retropubic prostatectomy and laparoscopic radical prostatectomy do not lead to significantly different rates of urinary incontinence postoperatively, Canadian researchers report in the February issue of the Journal of Urology.

"Recently," lead investigator Dr. Niels-Erik B. Jacobsen told Reuters Health, "laparoscopic and robotic prostatectomy have become popular among urologists and patients alike, based on improved visualization, meticulous dissection and shortened convalescence.  Critics of the laparoscopic technique question its oncologic efficacy and functional outcome."

Nevertheless, Dr. Jacobsen and colleagues at the University of Alberta, Edmonton note that numerous studies have demonstrated that the laparoscopic technique at a minimum provides comparable perioperative outcomes relative to the open approach in regard to postoperative blood loss, transfusion, analgesic requirements, hospitalization and convalescence.

To investigate whether there might be any advantage in regard to urinary incontinence, the researchers analyzed data prospectively obtained from 172 patients treated with open radical prostatectomy and 57 who underwent the laparoscopic procedure. All had clinically localized prostate cancer.

At 1 year, 13% of those who underwent the open procedure remained incontinent compared with 17% of those who underwent laparoscopic prostatectomy -- a nonsignificant difference. There were also no differences between groups in measures such as 24-hour urinary pad weight and urinary symptom scores.

Thus, continued Dr. Jacobsen, "the incidence and severity of incontinence 12 months postoperatively was similar between the two surgical groups.  Functional equivalence was maintained despite the fact that the laparoscopic group represented our initial experience with this technically demanding procedure.  We hypothesize that postoperative continence rates will improve -- and perhaps surpass open radical prostatectomy -- as our experience with laparoscopic or robotic prostatectomy expands."

In fact, he pointed out that he and his colleagues are currently comparing more recent groups of patients. "Until these data become available," he concluded, "we can assure our patients with prostate cancer who seek surgical treatment that the postoperative continence rates of laparoscopic prostatectomy are at the very least equivalent to those of open radical retropubic prostatectomy."

SOURCE:

•  Urol 2007;177:615-619.