Laparoscopic And Perineal Prostatectomy

Minimally invasive surgery has been popularized recently as patients generally return to work faster, have decreased postoperative pain and have shortened hospital stays. The laparoscopic radical prostatectomy, introduced in 1997 by Schuessler et al.,47 has not produced any advantage over retro-pubic prostatectomy in terms of return of sexual function. Schuessler initially reported laparoscopic prostatectomy on nine patients with preservation of potency in 50% of those patients potent preoperatively.47 Guillonneau in his laparo-scopic series reported a postoperative erection rate at 45% after only 3 months of follow-up.48 Salomon et al. found 25% of their patients postoperatively able to engage in sexual intercourse.49 While these initial potency rates fare well within the range seen for retropubic prostatectomy, the increased surgical time, steep learning curve, increased cost of intrumen-tation and similar surgical outcome make laparoscopic prostatectomy a procedure in evolution.47-49

Radical perineal prostatectomy, first introduced in 1901 by Proust and then in 1905 by Young,50 attempts to minimize postoperative morbidity while still offering excellent cancer control. In terms of sexual dysfunction after perineal prostatectomy, Harris etal. report 73% preservation of spontaneous erectile activity but 36% able to achieve vaginal penetration.51 Further research is needed to confirm the potency rates after radical perineal prostatectomy.

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