Morbidity of Radical Perineal Prostatectomy Following Transurethral Resection of the Prostate

Abstract

Radical prostatectomy in patients who have had prior transurethral resection of the prostate has been reported to result in significant morbidity. From 1974 to 1982, 30 patients who had had previous transurethral resection of the prostate underwent radical perineal prostatectomy for localized prostatic cancer. Operative time and blood loss were similar to a group of patients who had not had prior transurethral resection of the prostate. Over-all, 3 patients (10 per cent) had total incontinence and 3 (10 per cent) had stress incontinence requiring a pad or device. No patient undergoing radical prostatectomy less than 4 weeks or more than 4 months after transurethral resection of the prostate had postoperative incontinence. When radical perineal prostatectomy was performed between 4 weeks and 4 months after transurethral resection of the prostate the incidence of incontinence was 50 per cent. Five patients experienced prolonged perineal urinary drainage, all but 1 of whom healed spontaneously. Of the 6 patients with incontinence 3 had prolonged drainage. No patient had a rectal injury and there was no operative mortality. Two patients died without cancer and 1 has evidence of disease recurrence. We conclude that radical prostatectomy may be performed safely with acceptable morbidity following transurethral resection of the prostate and that if 4 weeks has elapsed since resection it might be advantageous to wait 4 months before performing radical surgery to lessen the risk of incontinence.

Prediction of Urinary Continence following Radical Prostatectomy

“…Prior transurethral resection of the prostate was shown to increase the risk of incontinence [12]. However, other authors, as Bass and Barrett [5], Lindner et al [13], Bandhauer and Senn [14], Steiner et al [3] and Ramon et al [8], could not confirm this finding.…”

“…Several factors that in all probability could influence the degree of incontinence after radical prostatectomy were investigated such as prior transurethral resection, age, operative techniques used, urodynamic parameters, adjuvant radiotherapy, surgical experience, the weight of the prostate, surgical margins status, pathological stage of the tumor and amount of blood loss during surgery [3,5,8,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]. The role of perineal reeducation in men with incontinence after prostatectomy has already been examined [27][28][29][30][31] but no controlled studies are yet available.…”

Anastomotic Stricture after Radical Prostatectomy

“…A radical prostatectomy after previous transurethral resection or open surgery (incidental carcinoma) has a high complication rate [2, 28, 29] especially with respect to the continence rate and anastomotic stricture formation. Stricture rates up to 33% (5–33%) have been reported in such cases [8, 9, 29].…”

Laparoscopic Radical Prostatectomy in Patients following Transurethral Resection of the Prostate

“…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.…”