[Radical prostatectomy: comparison of the perineal and retropubic route (40 patients). Preliminary results].

Transperineal radical prostatectomy, described at the beginning of the century for the treatment of prostatic cancer, is currently being reappraised following the development of surgical techniques allowing the dissection of subvenous external iliac nodes via a limited incision. Twenty four patients (group 1) underwent transperineal prostatectomy and 16 (group 2) underwent retropubic prostatectomy. The choice of surgical approach was left to the operator. We retrospectively compared the two groups. All patients had histologically proven prostatic cancer, clinically confined to the prostate. The operating time, the development of complications. the preoperative-postoperative haemoglobin difference, the number of patients transfused and the number of units transfused, urinary continence at three months and the histological results were studied. Three patients operated via the perineal approach and one patient operated via the retropubic approach suffered an operative rectal injury. The number of transfused patients (12.5% in group 1 and 37.5% in group 2) and the preoperative-postoperative haemoglobin difference for non-transfused patients (mean of 2.9 g/100 ml in group 1 vs 4.6 g/100 ml in group 2) were significantly different. No significant difference was observed between the two groups in terms of invasion of the prostatic capsule or seminal vesicles. Overall, only 106 out of 40 patients had a truly intraprostatic tumour, corresponding to understaging of the cancer in 60% of cases. Although the number of patients with imperfect continence was higher in group 1, the difference observed was not significant. The transperineal approach allows prostatectomy to be performed under similar oncological conditions to those of retropubic prostatectomy, while decreasing the operative blood loss.(ABSTRACT TRUNCATED AT 250 WORDS)