[Seminal vesicle sparing radical perineal prostatectomy]

Area of Science:

• Urology
• Surgical Oncology
• Oncology

Background:

• Radical prostatectomy is a primary treatment for prostate cancer.
• Comparing surgical approaches is crucial for optimizing patient outcomes.
• Seminal vesicle preservation is a debated aspect of radical prostatectomy.

Purpose of the Study:

• To compare the oncological and functional results of a seminal vesicle sparing modification of perineal nerve sparing radical prostatectomy (SV-RPP) with classical perineal (RPP) and retroperitoneal (RRP) approaches.
• To evaluate the safety and efficacy of SV-RPP.
• To assess the impact of seminal vesicle preservation on cancer recurrence and patient recovery.

Main Methods:

• A retrospective study of 702 radical prostatectomies (RPP and RRP) performed between July 2003 and December 2007.
• SV-RPP was utilized in 47% of RPP cases, with specific criteria for patient selection (PSA<10 ng/ml, Gleason sum<7, volume<50 ml).
• Comparative analysis of operative time, transfusion rates, anastomotic leak rates, surgical margin status, PSA relapse rates, and continence rates.

Main Results:

• SV-RPP demonstrated significantly shorter operative times (90 min vs. 144 min for RPP, 165 min for RRP).
• Lower rates of transfusion (3% vs. 9.1% RPP, 11.9% RRP) and anastomotic leaks (6.4% vs. 10.3% RPP, 27.8% RRP) were observed with SV-RPP.
• SV-RPP showed a significantly lower positive surgical margin rate (3.4% vs. 9.6% RPP, 8.4% RRP) and significantly better continence rates at 4 weeks (59.3% vs. 41.0% RPP, 45.4% RRP) and 12 months (95.7% vs. 86.4% RPP, 86.8% RRP).

Conclusions:

• SV-RPP is an improved perineal technique offering reduced intraoperative and postoperative complications.
• Oncological outcomes of SV-RPP are comparable to RPP and RRP.
• Preserving seminal vesicles in situ does not lead to increased PSA relapse rates, supporting its oncological safety.