PATHOLOGICAL FEATURES AND CLINICAL OUTCOME AFTER ANATOMIC RADICAL PROSTATECTOMY BY TRANSCOCCYGEAL APPROACH

Objectives. A nonrandomized prospective study was conducted aimed at v erifying the clinical outcome and pathologic features of a group of pa tients submitted to transcoccygeal radical prostatectomy. Methods. Rad ical transcoccygeal prostatectomy was performed at our institution in 26 patients after laparoscopic (24 cases) or open surgical (2 cases) p elvic lymphadenectomy. Eighteen patients were selected because they we re considered to be at risk for nodal metastases on the basis of preop erative staging (prostate-specific antigen level of 20 ng/mL or greate r and/or Gleason score greater than 5); the remaining 8 manifested inc idental prostate carcinoma. Results. Intraoperative complications incl uded rectal injury in 1 patient (3.8%) and massive blood loss in anoth er. Transitory leakage at the site of the urethrovesical anastomosis a nd urethrorectal fistula occurred postoperatively in 2 patients. The r ate of positive surgical margins was 26.9%. The mean follow-up time is 27 months (range 3 to 39 months). Total urinary continence was obtain ed in 21 patients (80.8%); 5 patients (19.2%) still require urinary pa ds. Four patients (15.4%) have experienced tumor recurrence evidenced only by increased serum prostate-specific antigen levels. Local tumor recurrence with positive biopsy of the urethrovesical junction was dia gnosed in 3 patients (11.5%), and 1 (3.8%) experienced systemic tumor recurrence. Conclusions. Radical transcoccygeal prostatectomy is a saf e procedure for the surgical treatment of prostate cancer, both from a clinical and a pathologic point of view. Operative complication as we ll as pathologic features and clinical outcome reported in this series of patients must be related to selection criteria used in most cases. The exact role of radical transcoccygeal prostatectomy in the clinica l setting has yet to be defined. According to these preliminary result s, radical transcoccygeal prostatectomy should be further investigated in the treatment of incidental carcinoma after transurethral resectio n of the prostate or suprapubic prostatectomy and could become an elec tive indication in such cases. (C) 1997, Elsevier Science inc.