Comparison of antegrade and retrograde laparoscopic radical prostatectomy techniques

We evaluated the effect of antegrade and retrograde approaches on functional recovery and surgical outcomes of extraperitoneal laparoscopic radical prostatectomy (LRP). We analyzed 135 patients who underwent extraperitoneal LRP, with the retrograde technique performed on 42 (31%; Group 1) and the antegrade technique on 93 (69%; Group 2). Both groups were statistically similar with respect to age, clinical stage, preoperative prostate-specific antigen (PSA) and American Society of Anesthesiologists (ASA) scores, prostate volume, and previous surgical history. Mean operative time was significantly longer in Group 1 (244 ± 18.3 vs. 203.3 ± 18.4 min, p < 0.001), whereas mean anastomosis times for both groups were similar (35.8 ± 7.2 vs. 34.7 ± 5.8 min, p = 0.155). Estimated blood loss and transfusion rates were significantly lower in Group 2. A significant difference was observed for both hospitalization (6.79 ± 3.3 vs. 5.46 ± 3.08 days, respectively; p = 0.026) and catheterization times (12.24 ± 2.1 vs. 11 ± 1.08 days, respectively; p = 0.001) for Group 2. The total complication rate was 47.6% in Group 1, and 11.8% in Group 2 (p < 0.01). Rates of positive surgical margins were 14.2% and 15% for Groups 1 and 2, respectively. At the 12-month interval from operation, similar recoveries in urinary continence were obtained for both groups (81% in Group 1; 91% in Group 2). Upon comparison of the two LRP techniques, we found that both were effective; however, the latter resulted in lower minor complication rate, lower blood loss, shorter operation time, and shorter length of hospital stay.