Open Complete Intrafascial Nerve-sparing Retropubic Radical Prostatectomy: Technique and Initial Experience

Abstract

To report our refinement of open intrafascial retropubic radical prostatectomy (OIF-RP) and 1-year follow-up results. OIF-RP was performed in 231 cases of clinically localized Prostate cancer in a prospective study from January 2007 to December 2009. Inclusion criteria were good potency (IIEF-5 score ≥ 15), Gleason score ≤ 6, prostate-specific antigen (PSA) ≤ 10, and clinical T1-2 tumors. Endopelvic fascia was not incised, and the prostate capsule was freed laterally from surrounding fasciae and dorsally from Denonvillier's fascia, keeping all periprostatic fasciae/nerves intact. Functional outcomes were followed at 3 and 12 months (3 M and 12 M). Continence defined as complete (no pads), grade I (1-2 pads/day) and grade II (>2 pads/day). Median age was 63.3 years, body mass index 25.6, and PSA 5.4 ng/mL. Median operating time was 65 minutes (range 50-250), blood loss was 150 mL (range 50-1000), preoperative IIEF-score was 23 (range 15-25). Pathologic stage was pT2 (91%) and pT3 (9%). Gleason score was ≤ 6 (73%) and ≥ 7 (27%). Positive margins were 10% (pT2) and 65% (pT3). There were no postoperative complications/reinterventions. At 3 M, 60% of patients had full continence, and 86% had full continence at 12 M (≤ 60 years, 64% and 95% after 3 M and 12 M, respectively). At 3 M and 12 M, median IIEF-score was 14 (range 0-25) and 19 (range 0-25), respectively. Baseline IIEF-score was reached by 50% (3 M) and 78% (12 M) (P<.001). IIEF-score was inversely correlated to patients' age (≤ 60 years 92%, 60-69 years 77%, ≥ 70 years 60%). OIF-RP follows rationales of radical prostatectomy and might be considered for selected patients. Preserving all periprostatic fasciae/nerves recuperates early continence and maintains potency without affecting oncological outcomes.