الفهرس 
Acknowledgement
Surgical anatomyOnly 14 pages are availabe for public view
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Abstract
Radical prostatectomy (RP) is the surgical treatment of PCa, which has been performed for more than 100 years and it is considered a gold standard treatment of PCa owing to the realization that hormone therapy and chemotherapy are never curative and that not all cancer cells can be eradicated consistently by radiation or other physical forms of energy, even if the tumor organ confined.
The optimal outcome after RP for clinically localized PCa is freedom from BCR along with the recovery of continence and erectile function, a so-called trifecta. Recently perioperative complications and positive surgical margins have been added to assess the success of the RP, which called pentafecta.
A combined retrospective prospective comparative study was designed to report and compare the perioperative parameters and 90-days complications after RP at the Department of Urology and Pediatric Urology of the University Hospital Schleswig-Holstein, Campus Kiel in the period between January 2011 and December 2015, and Department of Urology and Kidney Transplantation center, Martin-Luther University, Halle, Germany in the period between January 2013 and October 2014.
394 patients were included in this study of them 123 patients were treated by RALP, 220 patients treated by RRP and 51 LRP. The age distribution of men who underwent RP shows that about 87.5% were aged more than 60 years and only 13.5% were aged below 60 years. Most preoperative parameters are insignificantly difference between three groups of patients.
The complication rate was higher in older age; about 24.1% in men above 70s vs. only 4.6% in men blew 60s and the RALP had lower complication rates than RRP and LRP (38.2% vs. 53.6% vs. 47.1%; respectively).
The operative time was longer in obese patients (232 ± 75 min) compared to non-obese patients (232 ± 69 min), and less in LRP than RRP and RALP with mean skin-to-skin time (171.2±61.2 vs., 223.7±50.8 vs. 295.5±58.5 min.; respectively).
Catheterization time was shorter in RALP compared to RRP and LRP (8.4 ±4.3, 10.4 ± 5.6, 11.8 ± 9.4; respectively). Also the hospital stay was shorter in RALP compared to RRP and LRP with mean hospital stay (9.9 ±4 vs. 13.6 ±9.2 vs. 11.1 ±2.6 days; respectively). The overall PSM rates for RALP was slightly better compared LRP and RRP (21.9% vs. 25.5% vs. 36.4%; respectively, p = .021).
The rectal injuries were more common in RRP than LRP and RALP (1% vs. 0.3% vs. 0.5%; respectively). The ureteral injury was occurred in one patient (0.3%) underwent RRP due to marked retroperitoneal fibrosis and was treated by primary closure and insertion of a JJ stent.
The postoperative hemorrhagic complications were more common RALP compared to RRP and LRP (1% vs. 0.3% vs. 0%). The perioperative transfusion of packed RBCs and FFP was 5.1%. The transfusion rates were much less in LRP in comparison to RRP and RALP (3.9% vs. 5% vs. 5.9%; respectively).
Thromboembolic event was higher in RRP compared to RALP and LRP (1.8% vs. 1.6% vs. 1.7%; respectively, p = .986). UTI was insignificant lower in LRP and RALP compared to RRP (0%, 0.8% vs. 1.8%; respectively, p = .499). RALP and LRP significant lower SSI rate in compared to RRP (4%, 3.9% vs. 12.7%; respectively, p = .011)
Acute urinary retention was higher in LRP and RRP compared to RALP (1.9%, 0.9% vs. 0%; respectively, p = .372). Despite the extraperitoneal access of the RRP, we found lymphocele rate was higher in RRP compared to RALP and LRP (11.4% vs. 8.1% vs. 1.9%; respectively, p = .099).
The unplanned reoperation rate was significant less frequent in RALP and LRP compared to RRP (7.3%, 7.8% vs. 16.9%; respectively, p = .022). and the readmission rate was higher in RRP compared to LRP and RALP (5.5% vs. 3.9%, 4.8%; respectively, p = .897).
Patients, who underwent RALP, were likely to have longer operating time and higher intraoperative vascular injuries. However, they had fewer PSMs, overall complications, open conversion and unplanned re-operation. Patients, who underwent RRP, had longer hospitalizations time, higher overall complications, unplanned reoperating and readmission rate and SSIs. Patients, who underwent LRP, had shorter operating time and longer catheterization time.