Influence of perineal prostatectomy on anal continence

OBJECTIVE: Perineal prostatectomy has been proposed as a less invasive and safe procedure, but the risk of anal incontinence has been studied. This study aimed to evaluate the effects of perineal access on anal continence mechanisms after perineal prostatectomy. METHODS: From August 2008 to May 2009, twenty three patients underwent perineal prostatectomy. These patients were evaluated before surgery and eight months postoperatively using the Cleveland Clinic Anal Incontinence Score, the Fecal Incontinence Quality of Life Score, and anorectal manometry. RESULTS: The mean age of the subjects was 65 (range, 54-72) years, and the mean prostate weight was 34.5 (range, 24-54) grams. Gleason scores ranged from 6-7, and the mean Cleveland Clinic Anal Incontinence Score (mean±standard deviation) values were 0.9±1.9 and 0.7±1.2 (p>0.05) before and after surgery, respectively. The Fecal Incontinence Quality of Life Score did not change significantly after surgery. The mean values for anal manometric parameters before and after surgery were, respectively: Resting Pressures of 64±23 mmHg and 65±17 mmHg (p = 0.763), Maximum Squeezing Pressures of 130±41 mmHg and 117±40 mmHg (p = 0.259), High Pressure Zones of 3.0±0.9 cm and 2.7±0.8 cm (p = 0.398), Rectal Sensory Thresholds of 76±25 ml and 71±35 ml (p = 0.539), Maximum Tolerated Rectal Volumes of 157±48 ml and 156±56 ml (p = 0.836), and Sphincter Asymmetry Indexes 22.4±9% and 14.4±5% (p = 0.003). CONCLUSION: There was a significant decrease in the sphincter symmetry index after perineal prostatectomy. With the exception of the sphincter asymmetry index, perineal prostatectomy did not affect anal continence parameters.