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Radical Perineal Prostatectomy: A Viable Minimally Invasive Option for Treatment of Localized Prostate Cancer
Thomas K. Huisman, Robert M. Chiaramonte, Burkhardt H. Zorn
SOUTHERN MARYLAND HOSPITAL CENTER, CLINTON, MD

Introduction:
Although a proven technique for over 100 years, Radical Perineal Prostatectomy (RPP) has recently fallen out of favor as a surgical procedure of choice for treatment of localized prostate cancer. We report our experience with RPP and compare our Results with contemporary data for other surgical treatments.
Materials & Methods:
A retrospective review of 300 consecutive RPP patients in a single institution was performed. Patient demographics, hospital stay, perioperative and postoperative morbidity, postoperative complications and biochemical disease-free survival were reviewed.
Results:
Demographics: Average patient age was 61.5 years (range 36-76). Mean pre-op Gleason sum was 6(4-8). Average PSA was 6.5 (1.4-23.7). Average OR time was 100 minutes. Average EBL was 354 cc. Only 4/300 patients needed transfusion (1.3%) Average hospital stay was 1.3 days, but for the last 250 cases all patients have been discharged on POD 1. Average length of catheterization 7 days. Overall continence 91.4% (dry- no pads) and 5% minimal (1 ppd). 64% of bilateral nerve sparing patients have spontaneous erectile function.
Conclusions:

RPP is a well-tolerated and effective treatment for clinically localized prostate cancer. It is associated with less morbidity, shorter hospital stays and quicker recovery times than traditional retropubic prostatectomy. It compares favorably to robotic prostatectomy and may represent a cost-effective alternative, especially in specific patient populations, including morbidly obese patients, patients with renal transplant or history of extensive prior abdominal surgeries. These findings are increasingly relevant as the rising cost of health care delivery continues to come under intense scrutiny.


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