Comparative analysis of radical prostatectomy techniques using perineal or suprapubic approach in the treatment of localized prostate cancer / Análise comparativa das técnicas de prostatectomia radical perineal e suprapúbica na abordagem do câncer de próstata localizado

Objective: To compare the results of radical prostatectomy by perineal and suprapubic approaches as to operative time, procedure costs, and surgical site complications. Methods: The medical records of localized prostate cancer patients (PSA less than or equal to 10 ng/ml and Gleason score less than or equal to 6) were analyzed. Fifty-five patients were submitted to radical prostatectomy by perineal approach and 54 via suprapubic approach. Results: There were statistical differences between groups as to operative time (p < 0.05); for perineal approach it was in average 114 minutes (SD ± 0.03) and for suprapubic approach, an average of 167 minutes (SD ± 0.041). Prostatectomy via perineal approach resulted in 11 cases of surgical complications, and suprapubic approach, 3 cases. Conclusions: Radical prostatectomy via perineal approach took less time at a lower cost as compared to the suprapubic approach. However, there were more complications in patients submitted to perineal approach, mainly rectal lesions.

Objetivo: Comparar os resultados da prostatectomia radical por acesso perineal e por via suprapúbica quanto ao tempo operatório, custo de realização do procedimento e complicações do sítio cirúrgico. Métodos: Foram analisados os prontuários de pacientes com câncer de próstata localizados (PSA menor ou igual a 10 ng/ml e escore de Gleason menor ou igual a 6) sendo 55 submetidos à técnica de prostatectomia perineal e 54 à técnica suprapúbica (PRSP). Resultados: Houve diferença estatística entre os grupos quanto ao tempo operatório (p < 0,05). O tempo médio para a realização de todo o ato operatório por acesso perineal foi 114 minutos em média (DP ± 0,03) e de 167 minutos em média (DP ± 0,041) quando empregado o acesso suprapúbico. O índice de complicações cirúrgicas decorrentes das prostatectomias realizadas foi de 11 casos na prostatectomia radical perineal e de 3 casos submetidos à técnica suprapúbica. Conclusões: A prostatectomia radical pelo acesso perineal foi realizada em menor tempo com menor custo do procedimento quando comparada à operação realizada pelo acesso suprapúbico. Entretanto, relacionou-se a maior incidência de complicações em comparação ao acesso suprapúbico, principalmente com relação à lesão retal.

Comparison of radical prostatectomy techniques: open, laparoscopic and robotic assisted: [review]

INTRODUCTION: To review the current status of laparoscopic radical prostatectomy (LRP) and robotic assisted radical prostatectomy (RALP) in relation to radical retropubic prostatectomy (RRP) in the management of localized prostate cancer. MATERIALS AND METHODS: Between 1982 and 2007 published literature was reviewed using the National Library of Medicine database and the following key words: retropubic, laparoscopic, robotic, robot-assisted, and radical prostatectomy. Special emphasis was given to the technical and cost considerations as well as operative, functional and oncologic outcomes. In particular, reports with pioneering work that have contributed to the evolution of the technique, presenting comparative outcomes and with large series encompassing intermediate/long term follow-up, were taken into account. RESULTS: After intermediate term follow-up, LRP and RALP achieved similar oncologic and functional results compared to RRP. However, LRP and RALP were associated with decreased blood loss, faster convalescence and better cosmetics when compared to RRP. The RALP technique is undoubtedly more expensive. CONCLUSIONS: The oncologic and functional outcomes for LRP and RALP are similar to RRP after intermediate term follow-up. Long term follow-up and adequately designed studies will determine the inherent advantages and disadvantages of the individual techniques in the management of localized prostate cancer.

Desobstrução intra-vesical prostática com ou sem hernioplastia: estudo comparativo / Surgical treatment of prostatic infravesical obstruction with and without inguinal hernioplasty: comparative study

Estudamos quarenta e nove hernioplastias inguinais em pacientes que foram submetidos concomitantemente à cirurgia prostática para o tratamento de obstrução infravesical por via aberta ou endoscópica. Esse grupo foi comparado com pacientes submetidos somente à cirurgia prostática. O seguimento foi de pelo menos seis meses. O tempo de cirurgia foi significativamente maior no grupo da cirurgia combinada. Porém o número de dias de internação no período pós-operatório teve uma mediana de três dias para ambos os grupos. O tratamento da obstrução infra-vesical foi efetivo em todos os casos das cirurgias combinadas e a hernioplastia teve uma recidiva de 10 por cento. Cirurgias combinadas são práticas, bem toleradas e podem ser realizadas com segurança levando à economia de tempo e recursos.Forty-nine inguinal hernioplasty were studied in patients submitted to simultaneous prostatic surgery for the treatment of lower urinary tract obstruction either open or endoscopic. This group was compared to patients submitted only to the prostatic surgery. The minimal follow-up was six months. The operating time was significantly higher in the combination group. The average postoperative hospital stay was 3 days for both groups. The prostatic treatment was effective in all patients for the combined operation and the recurrence rate for the hernia treatment was 10 per cent. The combination procedure is practical and well tolerated saving time and financial resources...