Intrafascial endoscopic extraperitoneal radical prostatectomy

Objective To discuss the treatment efficacy of intrafascial endoscopic extraperitoneal radical prostatectomy(EERPE)in prostate cancer patients. Methods The operation was performed in 23 prostate cancer patients.The mean age was 65 years old.Preoperative prostate-specific antigen(PSA)level was 4.5-8.6(6.2±2.1)ng/ml,and patients distribution as Gleason Score 5 in 3 cases,Gleason Score 6 in 11 cases and Gleason Score 7 in 9 cases.Eighteen patients had preoperative potency.The technique was to keep the endopelvic fascia intact.The prostatic fascia was incised anterior medially from the base of the prostate.And the dissection plane was directly on the prostatic capsule.The bilateral and apex prostate fascia were stripped though this plane without inure the neurovascular bundle and external sphincter.All the 23 patients were followed up for 1 2 months. Results The mean operative time was 125 min(range:110-170 min).Hemorrhage was 320-1500(550±210)ml.Transfusion rate was 13%.Mean catheterization time was 12 d(range:9-15 d).At 12months postoperatively,87%of patients were continent(no need for pads),13%had minimal stress incontinence(1-2 pads).72%of 1 8 cases who had potency preoperative kept erections sufficient for intercourse with or without the help of PDE5 inhibitors.During the follow-up period,9%(2 cases)had biochemical recurrence. Conclusion The intrafascial EERPE may have limited trauma to the prostate surrounding fascias,the neurovascular bundles and the external sphincter. Key words: Prostatic neoplasms; Prostatectomy; Laparoscopes; Prostate fascia