Morbidity of radical retropubic prostatectomy following previous prostate resection

Abstract

A total of 153 patients with prior prostate surgery underwent a radical retropubic prostatectomy for carcinoma of the prostate. Ninety-seven patients had undergone transurethral resection of the prostate (TURP), and 56 patients had undergone suprapubic transvesical prostatectomy (SPP). In 115 patients, the diagnosis of malignancy was made at the time of transurethral resection or enucleation. No perioperative deaths occurred and no patient suffered rectal injury or ureteral transection. Operative time and blood loss were similar between the TURP and SPP groups and were not different in a group of patients who had not had prior prostate surgery. Early and late complications occurred in eight patients (5.2%), of whom seven had had previous TURP. Complete urinary control was achieved in 96% (147) of the patients; stress incontinence was present in 4% (6 patients); and no patient was totally incontinent. Postoperative complications and the occurrence of stress incontinence were not related to the time elapsed between the previous prostate surgery and the radical prostatectomy. Sexual function was preserved in 32 (71%) of the 45 patients in whom we performed a nerve-sparing radical prostatectomy. Residual cancer was found in the radical prostatectomy specimen in 77 (67%) of the stage A patients. Twenty-nine (25%) of the stage A and 13 (34%) of the stage B patients had pathological evidence of disease extension beyond the confined prostate. Follow-up was 6-92 months, with a mean of 32 months. Four patients died of prostatic cancer, two patients died without cancer, and five have evidence of disease progression; 142 (93%) are alive without evidence of disease. Although radical prostatectomy sometimes is more difficult after previous prostate surgery, operative complication rates, patient morbidity, and the opportunity for surgical cure are not different from those seen in patients with no history of previous prostate operations.

Laparoscopic Radical Prostatectomy in Patients following Transurethral Resection of the Prostate

“…Infections of the prostate and seminal vesicles and perforation of the prostate's capsule during TURP with extravasation of irrigation fluid, might result in peri-prostatic fibrosis and distortion of the surgical plains, making the dissection difficult [5,6,9] .…”

“…Preliminary data published so far suggest that laparoscopic radical prostatectomy has the same outcome as the open procedure in terms of continence and cancer control [1][2][3][4] . Previous transurethral resection of the prostate (TURP) has been shown to increase surgical difficulty during open radical retropubic [5] or perineal [6] prostatectomy without adversely affecting the outcome of the patients. We present our experience with LRP in patients following TURP.…”

Iatrogenic Rectal Injury During Radical Prostatectomy: Is Colostomy Inevitable End?

“…If the injury is not recognized during the operation complications can be observed postoperatively. After surgery the most important complications are rectourinary fistulas, peritonitis, infections related to the operation site, urinary incontinence, anastomotic strictures, sepsis and even death [13,5]. During the operation when we suspect rectal trauma we used digital rectal examination and insufflation air with a syringe into the rectum while filling the pelvis with irrigation fluid as described by some authors [9,14].…”

“…As a routine, colostomy is not required after primary repair of rectal wall. Colostomy may be necessary in limited cases with larger defects, intraoperatively missed defects, poor tissue quality, massive fecal spillage, fistula development, or in salvage radical prostatectomy procedures [13,17,18]. In the past systematic diverting colostomy was recommended but to avoid the added inconvenience, morbidity and cost of diverting colostomy in these cases, currently primary closure of the rectum without diverting colostomy has been advocated [19,20].…”

Rectal injury during radical prostatectomy

“…In contrast, several studies failed to find an increased risk in cases with a history of open prostatic adenomectomy or transurethral resection. [10,11] A novel technique was reported in a study by Albayrak et al, [12] and they recommended a circular incision of the bladder neck by endoscopic means to make the dissection of the bladder neck easier during perineal radical prostatectomy in cases with a previous history of prostatic surgery. Since none of our seven cases had a history of prostatic surgery, we did not use this technique; however, it may be helpful in decreasing the risk of rectal injury during radical prostatectomy in those cases with a history of prostatic surgery.…”