[Defecation problems following radical perineal prostatectomy. A prospective study]

The true incidence of bowel symptoms prior to radical prostatectomy, as evaluated by a differentiated questionnaire, is unknown. We therefore performed a prospective study on patients who were scheduled for radical perineal prostatectomy.

A total of 67 patients with cT1-cT3, N0, M0 prostate cancer underwent an extrafascial, radical, perineal prostatectomy. The patients received a questionnaire prior to surgery as well as 6 months and 12 months after surgery. This took into account demographic data, stool symptoms (Kelly questionnaire) and questions concerning bladder function (ICS male continence questionnaire). The questionnaires were evaluated by three of the authors not involved in patient care.

The mean age of the patients was 64 years. The PSA range was 0.9-55.6 ng/ml (mean 12.7 ng/ml). There were 47 pT2, 19 pT3 and a single pT4 tumour. A total of 59 patients had a Gleason score of 6 or less. Positive surgical margins were present in four patients. The 12 months follow-up questionnaire could be evaluated for 82% of the patients (n=55). In addition, 46 patients answered the questionnaire at 6 months post-surgery. Three or more problems in relation to bowel movements were reported preoperatively by 21% of the patients. Straining with bowel emptying was the symptom which was indicated most often. Stool smearing was reported by 13% of patients at least once or twice monthly. In addition, 6% of patients reported that they had difficulties in differentiating soft stool from gas. After 1 year, seven (13%) of the patients reported stool smearing which was not present prior to surgery. Six of these patients observed this problems only once or twice a month. Only one patient had stool smearing once a week. Two patients reported urgency, two had a decreased warning time and one reported decreased sensibility. Two patients used protective pads. The most frequent symptom reported postoperatively was straining with bowel emptying (24% preoperatively and 16% postoperatively).

It is evident that men scheduled for radical prostatectomy already have significant stool problems preoperatively. Newly developed, postoperative stool smearing on a daily basis occurred extremely seldom. They same is true for the discrimination between soft stool and gas. From our point of view, it is important to use the extrasphincteric approach to the prostate described by Young. Furthermore, the pubo-anal sling should be preserved.