Simple preoperative parameters to assess technical difficulty during a radical perineal prostatectomy

Area of Science:

• Urology
• Surgical Oncology

Background:

• Radical perineal prostatectomy (RPP) is a surgical procedure for prostate cancer.
• Predicting surgical difficulty can optimize patient outcomes and surgeon learning curves.

Purpose of the Study:

• To develop a practical method for predicting easier radical perineal prostatectomy (RPP) cases preoperatively.
• To identify key parameters that correlate with RPP surgical difficulty.

Main Methods:

• Fifty RPP cases were categorized into easier (Group I) and difficult (Group II) based on a 3-parameter difficulty scale.
• Measurements included skin-to-prostatic apex distance (SPAD), skin-to-prostatic base distance (SPBD), inter-ischial tuberosity distance (ITD), probe-divergence angle (PDA), and prostate volume (PV) via ultrasound.
• These parameters were compared between the two difficulty groups.

Main Results:

• Prostate volume (PV) and probe-divergence angle (PDA) were significantly different between easier and difficult RPP groups.
• Higher PDA (>45 degrees) and lower PV (<37.4 cc) were associated with easier cases.
• SPAD, SPBD, and ITD did not significantly differ between groups.

Conclusions:

• Preoperative ultrasound assessment of prostate volume and pelvic depth (via PDA) can predict RPP surgical difficulty.
• Selecting cases with lower prostate volumes and deeper localization may facilitate RPP, especially during the learning phase.
• This predictive method aids in planning RPP surgeries for improved efficiency and potentially better surgical outcomes.