654 ACHIEVING THE TRIFECTA WITH NERVE-SPARING RADICAL PERINEAL PROSTATECTOMY

Abstract

You have accessJournal of UrologyProstate Cancer: Localized1 Apr 2011654 ACHIEVING THE TRIFECTA WITH NERVE-SPARING RADICAL PERINEAL PROSTATECTOMY Wooju Jeong, Navneet Mander, Jesse Sammon, Quoc-Dien Trinh, Naveen Pokala, Emil Kheterpal, Shyam Sukumar, and Michael Harris Wooju JeongWooju Jeong Detroit, MI More articles by this author , Navneet ManderNavneet Mander Detroit, MI More articles by this author , Jesse SammonJesse Sammon Detroit, MI More articles by this author , Quoc-Dien TrinhQuoc-Dien Trinh Detroit, MI More articles by this author , Naveen PokalaNaveen Pokala Detroit, MI More articles by this author , Emil KheterpalEmil Kheterpal Detroit, MI More articles by this author , Shyam SukumarShyam Sukumar Detroit, MI More articles by this author , and Michael HarrisMichael Harris Detroit, MI More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1570AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The emergence of minimally invasive methods to treat clinically localized prostate cancer has led to increased awareness of the morbidity of the available methods of treatment. The treatment “Trifecta” following radical prostatectomy consists of undetectable PSA, pad-free urinary control and penetration quality erectile function. This study measures the effectiveness of nerve sparing radical perineal prostatectomy at achieving the Trifecta. METHODS Between January 2002 and August 2010, 387 men underwent nerve sparing radical perineal prostatectomy (RPP). Pre- and post-operative functional statuses, as well as oncologic, technique-related and demographic data, were prospectively collected. Postoperative PSA results were obtained every 3 months for the first year, every 6 months for the next 2 years and annually thereafter. Functional characteristics were assessed by physician-administered questionnaire at the same intervals. Oncologic control was defined as a PSA <0.1 ng/dL. Continence was defined as pad-free, full urinary control. Potency was defined as erectile function sufficient to penetrate vaginally to the completion of intercourse with/without PDE5 inhibitors. All three criteria were required to have achieved Trifecta outcomes. RESULTS Of the 387 men undergoing unilateral or bilateral nerve sparing RPP, 320 had >1yr of follow-up and were considered for analysis. Seventy-four and 45 patients were excluded for non-nerve sparing procedure or pre-operative impotence respectively; the final sample size was 201. Median follow-up was 38 months (IQR 18,48). Trifecta outcomes were achieved by 51.2, 68.7, 76.5 and 84.5% in patients with respectively 1, 2, 3 and 4 years of follow-up. CONCLUSIONS We present the largest series of nerve-sparing radical perineal prostatectomy performed in the modern era. Meticulous technique and attention to anatomical principles allows for excellent functional outcomes without sacrificing oncologic control. Nerve-sparing RPP represents a viable alternative to open, laparoscopic or robotic prostatectomy. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e265 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Wooju Jeong Detroit, MI More articles by this author Navneet Mander Detroit, MI More articles by this author Jesse Sammon Detroit, MI More articles by this author Quoc-Dien Trinh Detroit, MI More articles by this author Naveen Pokala Detroit, MI More articles by this author Emil Kheterpal Detroit, MI More articles by this author Shyam Sukumar Detroit, MI More articles by this author Michael Harris Detroit, MI More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...