Radical Prostatectomy: Is the Perineal Approach More Difficult to Learn?

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Abstract
We assessed the relative difficulty with which radical perineal and retropubic prostatectomy operations are learned. The first 10 radical perineal and retropubic prostatectomies performed by 6 graduating urology residents were reviewed for patient and tumor characteristics, duration of surgery and hospitalization, and complication rates. A total of 120 patients was reviewed. Mean hospital stay was 2.5 days less after radical perineal prostatectomy, and estimated blood loss, number of transfusions and complication rates were also less for this procedure. All parameters used to estimate the outcome of the procedure indicated that radical perineal prostatectomy was learned more quickly than radical retropubic prostatectomy. In a residency training program radical perineal prostatectomy was learned at least as easily as retropubic prostatectomy. Due to expanding indications for this procedure, these findings should encourage urological surgeons to develop their skill with this approach.