contemporary urology offers four types of prostatectomy : retropubic , perineal , laparoscopic , and robot - assisted . the same indications apply to all of them , but the latter two are in the limelight now  considered  minimally invasive procedures  and presumably less harmful . particularly , robot - assisted prostatectomy has become a buzzword topic for mass - media and to some extent for medical journals . a conviction that highly equipped and technologically sophisticated surgery is far more efficacious than the one is the main reason why sparks fly [ 2 , 3 , 4 ] . furthermore , ill - informed patients accept this view as truthful , being unable to distinguish marketing and conjectures from facts  but as wj catalona stated , the odds are that no modality provides substantial benefits over another and does not demonstrate an overwhelming superiority . each option has characteristic advantages and disadvantages and inevitably impacts the patient 's former way of life . . the valuation of any method , beside assessment of objective medical parameters , should encompass patients personal opinions and feelings . the logic of removing a malignant tumor might be foiled by the need for continence and sexual status , which are regarded as independent and reliable predictors of satisfaction . possible incontinence and/or impotence mostly have a negative impact on a patient 's quality of life . however , many patients accept the post - prostatectomy consequences in exchange for cancer removal   while others do not reconcile with a deterioration in their previous quality of life . a given patient may assess mild incontinence as acceptable but , for another , even a subtle drip may be devastating . an objective measure of those subjective assessments is readiness to undergo the same treatment again , correlating with patient satisfaction even under the threat of similar complications . detailed evaluations of men after prostatectomy have been published previously as a multicenter or comparative study ( tables 2 & 3 ) . however , such surveys have limitations linked to their essential subjectivism . the point at issue is a discrepancy between the outcomes reported by patients and those reported by scholars the purpose of the following paper is to estimate social outcomes of perineal prostatectomy performed at the same institution by the same team , examined by means of mail - in questionnaires . the term  social  refers to the patient 's personal assessment of continence and sexual status , recovery rate with reference to the preoperative expectations , and individual quality of life . the perineal approach for treatment of prostate carcinoma was described and performed by young in 1904 . after being improved by other contributors , the radical perineal prostatectomy ( rpp ) fell into oblivion while the retropubic approach became a gold standard in the treatment of localized prostate carcinoma . later , however , both of these procedures were overshadowed by the introduction of laparoscopic and robot - assisted procedures . given the number of published data , for economic and medical reasons , perineal prostatectomy has become recognized as an excellent minimally invasive procedure by many authors . rpp has been implemented in our center after training under the kind auspices of doctor h - j keller in the department of urology , hof , germany . in the years 2008 - 2009 , the first set of 47 patients with localized prostate adenocarcinoma underwent perineal prostatectomy ( average age : 62.5 years ) . two of the patients had simultaneous transperineal lymphadenectomy , and 11 of them ( 23.4% ) underwent a nerve - sparing procedure . operation parameters : average time was 110 min ; mean blood loss was 350 ml . postoperative period : mobilization and oral nutrition on 1st day postop ; median hospital stay was 3.8 days ; catheter removal on 7 - 10 day ; suture removal on 10 day . patients were assigned to rpp as candidates unsuitable for laparoscopy  some due to the patient 's deliberate choice . participants were mailed a uniform questionnaire ( constructed by one of authors ) consisting of 10 polynomial items regarding continence , potency , and self - perceived satisfaction of treatment . from among 47 patients to whom questionnaires were sent , 26 patients returned a completed form ( response rate 55.3% ) . 26  because some answers overlapped ( ie . q2a and q2b ) or a given situation did not occur ( ie . since evaluation was based on a patient 's subjective opinions , some items might have been answered imprecisely ( ie . 91.7% were satisfied with the chosen treatment and 8.3% regret their previous decision and do not accept its consequences despite the fact that they were informed before the surgery ( two patients did not answer ) . such favorable results are interesting in light of q1 , where 69.2% patients reported the presence of any inconvenience related to the past surgery . in particular , 38.5% of the patients reported any degree of incontinence and 76.9% reported sexual dysfunction . from ten incontinent patients : 80% leaked sporadically in the daytime only during strenuous activity and 40% suffered from urgency with subsequent leakage . volume of reported leakage was generally a little : 40% patients up to 100 ml , and 90% of them only a few drops . from among all respondents , 60% for prevention only , and 50% used up to three pads daily . in summation , 69.3% of all patients are fully continent , 19.2% are  social dry  according to established classifications defined as using up to three pads per day , and 11.5% are essentially incontinent . a significant number of patients reported considerable improvement in continence with time ( 50% of the entire cohort ) . this favorable trend was observed essentially during the first six months after the procedure ( nearly 90% of initially incontinent cases ) . overactive bladder symptoms such as nocturnal or morning urge to void affected nearly 27% of patients , but with moderate intensity 85.7% of them reported up to three involuntarily bladder contractions per night . in terms of sexual function , the survey yielded less advantageous results ( with the reservation that patients did not use pharmacological or other aid ) . self - assessed loss of pre - treatment sexual efficiency was reported by 76.9% of all respondents and only 23.1% had various degrees of erection . from among all the respondents , only five men ( 19.2% ) were able to keep an erection to penetrate , but only two ( 7.7% ) described intercourse as  satisfying  for adequate penile firmness and one ( 3.8% ) has only nocturnal erections . as erectile outcomes are converted with reference to nerve sparing cases ( nine of the 26 responders ) , 66.7% have spontaneous erections , 55.5% undertake sexual activity , but only 40% of them describe sexual function as  satisfying  . first , this is an evaluation of the first group of patients undergoing radical perineal prostatectomy at our institution . secondly , questionnaires were completed by patients whose answers may not have reflected their actual status  answers obtained during physician interview may differ ( be more precise ) . thirdly , the majority of evaluated patients underwent rpp as unsuitable for laparoscopy ( previous surgery , comorbidity , obesity , etc . ) . difficult patients  in terms of surgical determinants , usually prone to less favorable outcomes . some patients opted for rpp as the preferred treatment after preoperative counseling and presentation of pros and cons of different methods . satisfaction surveys after a given procedure are by no means a new concept in medical literature . many publications brought up this issue as an important assessor for a variety of procedures , even after anesthesia . though not substantial , the number of our patients is comparable with other single - institution studies cited in worldwide literature ( see tables 2 and 3 ) . it should be noted that massive cohorts usually come from multicenter , or even multinational databases and cover the outcomes of numerous urologists . however , the analysis of accumulated diverse results , otherwise admirable , interesting and worthwhile , raises some reservations as well . the outcomes presented in our material ( table 1 ) are convergent in terms of continence , potency , and patients satisfaction with other reported outcomes after retropubic , laparoscopic , or robot - assisted procedures and approximate to the results of other authors who may have been more skilled in the rpp procedure . overall , studies locate continence rate from 96% to 71% . however , one large ( 1,069 participants ) multicenter survey revealed only a 34.5% rate of self - reported total continence ( see table 2 ) . 88.5% fully continent or  social dry  ( 69.3% and 19.2% respectively ) , only one patient fully incontinent  are satisfactory in comparison to such outcomes after retropubic ( from 97.1%  socially continent  to 61%  not requiring protection  ) , laparoscopic ( from 91.9%  up to one pad  to 80.7%  no protection  ) , or robot - assisted ( from 90%  no leak in response to the question  to 71%  return to baseline  ) procedures . furthermore , our results are close to other published results of rpp ( from 96%  free of pad  to 94%  occasional dribbling  ) . 
  in turn the issue is that definitions in  erectile surveys  vary considerably with different sources , possibly due to the sensitive and elusive nature of this matter , the author 's bias , and/or ambiguity of classification . last but not the least , it is difficult to compare different groups of surveyed patients . evidently , the outcomes of a diverse set of patients compare unfavorably with the highly selected ones ( homogenous with respect to t , gleason score , pretreatment erectile status , age , comorbidity , body composition , etc . ) . the definition of satisfactory sexual outcomes differs according to different authors from  return of any erections  through  erection sufficient for vaginal penetration postoperative erectile status of our patients may be a reliable estimate with reference to the nerve - sparing subset . of those men , 66.7% had spontaneous postoperative erections and 55.5% undertook sexual activity ( described as  satisfactory  by 22.2% ) . this small group bears comparison with the published sexual outcomes of nerve sparing procedures  retropubic : from 50%  erections adequate enough for penetration  to 11%  fully potent  , laparoscopic : from 62% and 52.5%  erections within one year  to 0% robot - assisted : from 81%  any erectile function  to 50%  erections adequate enough for penetration at 6 month  to 32.7%  fully potent at 12 month  . our results are similar to the sexual outcomes of rpp published elsewhere ( from 80%  any erections  to 41%  erection sufficient for vaginal penetration  ) . satisfaction outcomes evolving from completed surveys of our patients are approximate to and stand in comparison with the data presented in table 4 . the vast majority of men ( 91.7% ) accept their overall quality of life following prostate surgery and confirm satisfaction with the chosen treatment . the interpretation and analysis of patient 's satisfaction after the point at issue is that satisfaction is molded by awareness of the goals of an undertaken treatment and the disease at hand . it is worthy to mention that patients satisfaction seems to be unrelated to the type of chosen treatment . an oft - cited article states that 19% of patients after prostatectomy regret their choice regardless of its type . surprisingly , the most discontent are patients after the robot - assisted procedure due to groundless sky - high expectations driven by media misinformation and touted by some market - oriented professionals . for this reason :   urologists need to stop telling patients that one technique of performing rp is better or worse than any another because this assertion is currently unsupported by published data . evidence available to date strongly suggests that all techniques will perform as well , or as badly , as each other , in contrast to the surgeons utilizing them  . moreover the highest regret rate is noted among patients with low socioeconomic status [ 10 , 12 ] . other surveys reveal that functional outcomes , post - treatment quality of life , and satisfaction with the past treatment are similar regardless of prostate cancer treatment type ( surgery vs. brachy- or radiotherapy ) as long as effective oncologic goals were accomplished [ 5 , 13 ] . an interesting comprehensive article on post - treatment satisfaction among patients who chose from prostatectomy , brachytherapy , conformal radiotherapy , or active surveillance revealed that nearly 88% were satisfied with therapy and that proportion was similar regardless its type . it is wholly justified to name laparoscopic and robot - assisted procedures as  minimally invasive surgery  . the authors intentionally used the aforementioned term ( originally by previous authors ) with reference to rpp only to emphasize its limited , low - morbidity  impact on a patient 's state when compared to the laparoscopic procedure [ 7 , 8 ] . our study demonstrates radical perineal prostatectomy as an outcome - effective method of surgical treatment of localized prostate carcinoma . this procedure enables radical cancer resection with favorable functional results comparable to outcomes reported for other types of prostatectomy . acceptance and satisfaction rate of our patients does not lag behind other surveys . in our opinion , perineal prostatectomy undoubtedly meets the requirements of a well - tolerated surgery for patient 's comfort , cosmesis ( 8-cm - long hidden incision ) , omission of muscle groups , short recovery , and satisfying functional outcomes . its advantages have been recapped by a prominent urologist :  there is no doubt that  perineal prostatectomy meets every goal of minimally invasive surgery  .
introductionthis study evaluates the functional outcomes and satisfaction of an initial series of 47 patients after radical perineal prostatectomy performed in our department.material and methodsthe first set of 47 consecutive patients underwent perineal prostatectomy during 2008 and 2009 . 
 continence , sexual outcomes , and satisfaction of the treatment were evaluated using a self - reporting questionnaire , which was mailed to all patients after 15 to 33 months of follow - up . 
 26 patients ( 55.3% ) returned a completed form and participated in the study . 
 additionally , final outcomes were compared to results reported elsewhere.resultsamid respondents , 91.7% were satisfied with the chosen treatment and 8.3% regret the previous decision . 
 38.5% patients reported any urine leakage , 15.4% drip up to 100 ml a day , and only one patient ( 3.8% ) was totally incontinent . 
 76.9% men report a decline in prior sexual function . 
 six patients ( 23.1% ) patients have any degree of spontaneous erections and undertake sexual activity . 
 however , as erectile outcomes are adjusted to nine nerve - sparing cases , 66.7% have spontaneous erections and 55.5% undertake sexual activity , but only 40% of them describe their sexual function as satisfying.conclusionsour survey demonstrates that , because of short operating time , fast recovery , low postoperative pain score , early patient mobilization and feeding , and a small ( 8 - 10 cm ) and inconspicuous skin incision , radical perineal prostatectomy fully deserves to be recognized as a low - morbidity procedure . 
 the perineal approach provides a quality of life and patients satisfaction rate comparable to trendy , highly equipped procedures and emerges as an attractive alternative to them . 
 even novice  perineal surgeons  may achieve favorable results .