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Radical prostatectomy after previous prostate surgery: clinical and functional outcomes
Renzo Colombo1, Richard Naspro, Andrea Salonia
1Department of Urology, University Vita-Salute San Raffaele, Scientific Institute Hospital San Raffaele, Via Olgettina 60, 20132 Milan, Italy. colombo.renzo@hsr.it
The Journal of Urology
|November 7, 2006
Summary
Radical retropubic prostatectomy after prior bladder outlet obstruction surgery is feasible but technically demanding. Functional outcomes like continence and erectile function are less predictable than in primary cases.
Area of Science:
- Urology
- Oncology
- Surgical Outcomes
Background:
- Radical prostatectomy is increasingly used for localized prostate cancer, including cases following prior surgery for benign conditions.
- This trend raises questions regarding oncological and functional results in a secondary surgical setting.
Purpose of the Study:
- To evaluate the safety and outcomes of radical retropubic prostatectomy performed as a second-line treatment for prostate cancer after previous surgery for bladder outlet obstruction.
Main Methods:
- A cohort of 109 patients who underwent radical retropubic prostatectomy between 1999-2003 after prior prostate surgery for bladder outlet obstruction was analyzed.
- Patients had previously undergone transurethral resection of the prostate (88) or open prostatectomy (21).
- Perioperative morbidity was assessed, and functional outcomes (urinary continence, erectile function) were evaluated via questionnaire in a subset of patients.
Main Results:
- Radical retropubic prostatectomy as a second surgery was technically more complex with longer operative times compared to primary procedures.
- Postoperative morbidity showed a moderate increase.
- Urinary continence rates were 74% at 6 months and 86% at 12 months.
- Adequate erectile function was reported by 12% of patients.
Conclusions:
- Radical retropubic prostatectomy can be safely performed after prior surgery for bladder outlet obstruction, but requires significant surgical expertise.
- Patients should be counseled that functional outcomes, particularly erectile function, may be less predictable and satisfactory compared to primary radical prostatectomy.