Objective: Radical prostatectomy is the recommended treatment for localized prostate cancer; however, it is an invasive procedure that can leave serious morbidity. Robot-assisted radical prostatectomy was introduced with the aim of reducing postoperative morbidity and facilitating rapid recovery compared to the traditional Walsh's open radical retropubic prostatectomy. Therefore, a protocol was developed to perform an open prostatectomy comparable to that performed by robotics, but without involving novel instrumentation. Methods: A total of 220 patients diagnosed with localized prostate cancer underwent radical prostatectomy. They were divided into two groups: anterograde technique (115 patients) and the retrograde method (105 patients). The study outcomes were observed 3 months after surgery. Results: No differences were found in terms of surgical time, hospital stay, and suction drainage. However, reduced bleeding was observed in the anterograde technique (p=0.0003), with rapid anastomosis duration (p=0.005). Among the patients, 60.9% undergoing the anterograde technique were continent 3 months after surgery compared to 42.9% treated by the retrograde method (p=0.007). Additionally, fewer complications in terms of the number (p=0.007) and severity (p=0.0006) were observed in the anterograde technique. Conclusion: The anterograde method displayed increased efficiency in reducing complications, compared to the retrograde technique.
. [J]. Asian Journal of Urology, 2023, 10(2): 151-157.
Fabricio B. Carrerette,Daniela B. Rodeiro,Rui T. F. Filho,Paulo A. Santos,Celso C. Lara,Ronaldo Damião. Randomized controlled trial comparing open anterograde anatomic radical retropubic prostatectomy with retrograde technique. Asian Journal of Urology, 2023, 10(2): 151-157.
Days with indwelling bladder catheter, median (IQR)
14 (14-15)
7 (7-7)
<0.0001a
Nerve sparing, n (%)
0.0009b
Absent
34 (32.4)
14 (12.2)
Unilateral
46 (43.8)
59 (51.3)
Bilateral
25 (23.8)
42 (36.5)
Surgical complication, n (%)
0.007b
Absent
76 (72.4)
100 (87.0)
Present
29 (27.6)
15 (13.0)
Clavien-Dindo classification, n (%)
0.0006b
Grade I
2 (1.9)
7 (6.1)
Grade II
18 (17.1)
3 (2.6)
Grade III
9 (8.6)
5 (4.3)
Gleason score, n (%)
0.11b
6
15 (14.3)
22 (19.1)
7
79 (75.2)
72 (62.6)
8 or 9
11 (10.5)
21 (18.3)
Pathologic stage, n (%)
0.22b
pT2a
4 (3.8)
11 (9.6)
pT2b
12 (11.4)
17 (14.8)
pT2c
68 (64.8)
60 (52.2)
pT3a
7 (6.7)
13 (11.3)
pT3b
14 (13.3)
14 (12.2)
Lymph node, n (%)
0.28b
Negative
65 (98.5)
82 (95.3)
Positive
1 (1.5)
4 (4.7)
Surgical margin, n (%)
T2 negative
64 (76.2)
66 (75.0)
0.85b
T2 positive
20 (23.8)
22 (25.0)
T3 negative
12 (57.1)
19 (70.4)
0.34b
T3 positive
9 (42.9)
8 (29.6)
Biochemical recurrence, n (%)
0.69b
Negative
94 (89.5)
101 (87.8)
Positive
11 (10.5)
14 (12.2)
Continence, n (%)
0.007b
Absent
60 (57.1)
45 (39.1)
Present
45 (42.9)
70 (60.9)
Sexual potency, n (%)
0.34b
Absent
94 (89.5)
98 (85.2)
Present
11 (10.5)
17 (14.8)
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