The three incisions used in three variants of radical prostatectomy: open (midline incision), open (Pfannestiel) and laparoscopic or robotic (six ports) were compared.
The study was a cosmetic survey offered to men ages 40 to 70 years, without abdominal scars. It was conducted from 2008 to 2010. Study participants were shown a set of six pictures: printed photos of a midline incision (10cm), Pfannestiel incision (10 cm) and six ports incisions taken 3 months after surgery with and without boxer shorts underwear. Assessed data included age, profession, marital status, educational degree, BMI, and exercise activity (at least once a week). The instrument assumed oncological and functional outcomes equivalency including postoperative pain. The primary end-point for candidates was incision preference.
A total of 577 of 612 invited men (94%) completed the survey. Median age was 58 years. There were no significant differences between educational degree, marital status and BMI regarding choice of incision. Ports, Pfannestiel or midline incision were chosen 301 (52%), 265 (46%) and 11 (2%), respectively. On uni- and multivariate analysis, the only variable that was highly significant was exercise activity. A subanalysis of this group found that 85%, 10% and 5% reported a preference for the Pfannestiel, port incisions and midline respectively (p<0.01). The main reasons to choose Pfannestiel approach (90%) was the invisible-scar appearance wearing underwear.
Presented by Juan I. Martinez-Salamanca, MD, et al. at the 26th Annual European Association of Urology (EAU) Congress - March 18 - 21, 2011 - Austria Centre Vienna, Vienna, Austria
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