Radical prostatectomy after previous prostate surgery: effects on surgical difficulty and pathologic outcomes

To evaluate the surgical difficulty and pathologic outcomes of patients who had undergone radical prostatectomy after previous prostate surgery.

A total of 45 patients with previous prostate surgery underwent radical retropubic prostatectomy for prostate cancer. The surgical difficulty and pathologic outcomes for this group of patients (group 1) were compared with those for 50 consecutive patients who had undergone radical retropubic prostatectomy as their only prostatic surgery (group 2). The estimated blood loss and operative time were accepted as surrogates for surgical difficulty. Surgical margin status, seminal vesicle invasion, and extracapsular extension were evaluated to determine the pathologic outcomes. Late complications, including urinary incontinence and anastomotic stricture, were also assessed.

Radical prostatectomy was technically more challenging in the patients after previous prostate surgery compared with surgery-naive patients, with significantly more estimated blood loss (P <.05) and a longer operative time (P <.001). A unilateral or bilateral nerve-sparing procedure was performed in only 9 patients in group 1 but in 35 patients in group 2, resulting in low potency rates in group 1. The mean hospital stay was significantly longer in group 1. The continence rate was significantly greater in surgery-naive patients. No difference was found between the groups with regard to the rate of seminal vesical invasion, extracapsular extension, and surgical margin status.

Although radical retropubic prostatectomy is technically more difficult after previous prostate surgery, it can be performed safely with no difference in pathologic outcomes from those seen in patients with no history of prostate surgery.