Postsurgical management of the patient undergoing radical prostatectomy

Radical prostatectomy is a useful procedure for the treatment of prostate cancer limited to the gland; however, failure may occur as a result of the immediate or delayed complications of surgery, or to disease recurrence related to incomplete tumour excision. Seventy-nine radical prostatectomies were performed between April 1985 and August 1991 in patients with prostate cancer (primarily stage B1) who averaged 63 years of age. Immediate post-operative complications included vesicocutaneous fistulae, cystic lymphangiomas, abdominal wall abscesses, extraperitoneal haematoma, acute cholecystitis, and enterocutaneous fistula. Massive pulmonary embolism accounted for 2 deaths. Of the 77 surviving patients followed up for an average of 34 months, 79.2% (61) were continent, 15.6% had stress-related incontinence or severe incontinence and 5.2% were lost to follow-up. Sexual potency was preserved in 13 of the 33 patients (39%) who were pre-operatively potent. A favourable outcome as defined by no recurrence was seen in 69 patients (87.3%). Four patients (5.1%) are living with recurring prostatic cancer and 1 patient has died of the disease 46 months after surgery.