Nerve Sparing Endoscopic Extraperitoneal Radical Prostatectomy– Effect of Puboprostatic Ligament Preservation on Early Continence and Positive Margins

IntroductionA technical modification of nerve sparing endoscopic extraperitoneal radical prostatectomy (nsEERPE) with preservation of the puboprostatic ligaments is presented and compared to a previous techniique.Materials and methodsnsEERPE was performed in 100 men with clinically localized adenocarcinoma of the prostate from March 2004 through February 2005. Patients were divided into two groups: Group A included patients in whom a standard nsEERPE was performed (n = 50), and group B included patients in whom a puboprostatic ligament sparing nsEERPE was performed (n = 50). The postoperative follow-up was 2 weeks and 3 months evaluating preliminary effects on early continence and positive margins.ResultsThe early return to continence at 2 weeks postoperatively was achieved by 6 patients (12%) in group A, and 12 patients (24%) in group B. Three months after the procedure 24 (48%) and 38 (76%) patients were continent, in groups A and B respectively. Cli.nical outcome (early continence) was significantly better for Group B patients, at 2 weeks (chi-square test, p = 0.0019) and at 3 months (chi-square test, p = 0.0347) following surgery. No cases of complete or severe incontinence (more than 5 pads/day) were observed at 3 months after surgery, in either groups. Groups A and B did not exhibit significant differences regarding their histological status. In group A, positive margins were detected in 6.5% and 26.3% of patients with pT2 and pT3, respectively. In group B, positive margins were found in 3.2% and 15.8% of patients with pT2 and pT3, respectivelyConclusionWe propose the use of puboprostatic ligament-sparing nsEERPE as an intriguing method to ascertain recuperation of early continence after nerve sparing procedures, without hindering the final oncological outcome