Issue of Prostate Gland Size, Laparoscopic Radical Prostatectomy, and Continence Revisited

Objectives: To evaluate the influence of prostate gland size on the perioperative, pathologic, and continence outcomes after laparoscopic radical prostatectomy (LRP). Methods: 144 LRPs for which 18-month continence data were available were performed by a single surgeon, and were retrospectively reviewed. Patients were divided initially into two groups based on final prostate gland size: group 1 (weight less than 50 g) and group 2 (weight 50 g or more). Group 2 patients were stratified into group IIa (weight 50 to 70 g) and Group IIb (weight 70 g or more) to further examine the effect of gland size on continence. Results: Larger glands had higher mean prostate-specific antigen (P <0.05) but among groups there were no significant differences in patient age, Gleason sum, pathological stage, operative time, intraoperative blood loss, or positive margin rate. We noted a significant difference in mean time to recovery of continence for patients with small glands versus large glands: group 1 (8.2 months), group 2 (9.9 months), group IIa (8.5 months), and group IIb (13.8 months) (P <0.05). Conclusions: Prostate gland size had no effect on perioperative outcomes. However, recovery of postoperative continence can be delayed in patients with large prostates.