Management of the complications of radical prostatectomy

Abstract

Over the past several years, the morbidity associated with radical prostatectomy has improved due to advances in surgical technique, better understanding of male pelvic anatomy, and improved perioperative care. Despite these advances, patients are still at risk for several complications both intraoperatively and in the postoperative course. These risks include significant blood loss, rectal injury, ureteral injury, thromboembolic events, urinary incontinence, impotence, and a perioperative death rate of less than 1%. These risks should be reviewed and discussed before treating the patient with prostate cancer.

Established Prostate Cancer Susceptibility Variants are not Associated with Disease Outcome

“…Considering the adverse effects associated with radical therapy (22), and that most men affected with prostate cancer will die with—rather than from—this disease (23), there is an urgent need for improved tools to distinguish lethal from indolent disease at diagnosis. Identification of genetic markers associated with lethal prostate cancer hold promise to advance the understanding of the biological aspects behind the metastatic potential of prostate cancer.…”

Management of Complications of Prostate Cancer Treatment

“…Rectal injury during RP has been reported in 0.3% to 3.8% of cases. 10,22 During RRP and RPP, most rectal injuries occur while transecting the rectourethralis muscle. 23,24 In a series of 1,000 LRP, Guillonneau et al reported 13 rectal injuries, 10 of which occurred during dissection of the posterior surface of the prostate at the apex.…”

“…A better understanding of pelvic anatomy, including the vasculature and innervation surrounding the prostate, has led to a significant decrease in the mortality and relative morbidity for patients undergoing RP. 10,11 Furthermore, improved surgical training and the establishment of centers specializing in minimally invasive surgery have increased the popularity of laparoscopic (or robotic-assisted laparoscopic) radical prostatectomy (LRP) for the treatment of localized prostate cancer. Minimally invasive techniques such as LRP have also led to a decreased length of stay, shorter convalescence, and improved cosmesis.…”

Rectal injury during radical prostatectomy

“…[3] Importantly, there has been a decrease in the rate of rectal injury during radical prostatectomy operations in recent years, which may be due to the more refined surgical techniques and increasing anatomical knowledge of the male pelvis. [4] Previous studies have suggested that the rates of rectal injury are higher when the surgeon is unfamiliar with radical prostatectomy. Indeed, Heinzer et al [5] reported a rectal injury rate of 2% among patients who were operated upon later in the study compared with 7.8% in the group of patients who were operated upon at the beginning of the study.…”