Seminal vesicle sparing radical perineal prostatectomy [Samenblasenerhaltende radikale perineale Prostatektomie]

Background: The early and mid-term oncological and functional results of a seminal vesicle sparing modification of perineal nerve sparing radical prostatectomy (SV-RPP) was compared to the classical perineal (RPP) and retroperitoneal (RRP) approaches. Materials and Methods: From July 2003 to December 2007, 702 radical prostatectomies (417 RPP, 285 RRP) were performed by 3 surgeons (mean follow-up 17 months, range 0-48 months). RPP was chosen under the following conditions: PSA<10 ng/ml, Gleason sum<7 and volume<50 ml. A seminal vesicle sparing technique (SV-RPP) was used in 47% of the RPPs. Results: With a significantly shorter average operation (OR) time (SV-RPP 90 min, RPP 144 min, RRP 165 min), transfusion rate (SV-RPP 3%, RPP 9.1%, RRP 11.9%) and rate of anastomotic leaks at day 10 (SV-RPP 6.4%, RPP 10.3%, RRP 27.8%) the pT2 positive surgical margin rate with SV-RPP (3.4%) was significantly lower than with RPP (9.6%) and RPP (8.4%). For pT2-R0 tumors PSA relapse>0.2 ng/ml occurred in 12.5%, 13.6% and 8.2%, respectively (not significant). Continence rates (0-1 pad) for SV-RPP were significantly better compared to RPP and RRP after 4 weeks (59.3%, 41.0% and 45.4%, respectively) and 12 months (95.7%, 86.4% and 86.8%, respectively) Conclusions: SV-RPP represents an improved perineal technique with respect to intraoperative and postoperative complications whilst maintaining an oncological outcome comparable to RPP and RRP. Leaving seminal vesicles in situ did not result in increased PSA relapse rates. © 2009 Springer Medizin Verlag.