Continence, potency and morbidity after radical perineal prostatectomy

We investigated continence, potency and morbidity rates associated with radical perineal prostatectomy.

We assessed 220 consecutive men who underwent radical perineal prostatectomy for clinically localized prostate cancer between January 1984 and July 1995. Concomitant pelvic lymphadenectomy was performed in 181 patients. Potency was assessed in a subset of 50 consecutive men with good preoperative potency and a minimum 18-month followup who were otherwise candidates for a nerve sparing procedure (22 bilateral and 28 unilateral). Continence and potency were prospectively evaluated.

Continence was preserved in 208 of the 220 men (95%), and it returned in 23% by 1 month, 56% by 3, 90% by 6 and 95% by 10. Advanced age was the only significant risk factor. All 12 incontinent men (5%) were 69 years old or older and they represented 12% of that age group (12 of 103). After nerve sparing potency was preserved in 35 of the 50 fully potent men (70%), returning in 24% by 6 months, 50% by 12, 64% by 18 and 70% by 24. Unilateral nerve sparing preserved potency in 19 of 28 men (68%). There were no deaths but serious morbidity developed in 5 patients (2%). Anastomotic stricture, inadvertent proctotomy and venous thromboembolism occurred in 3 men (1%), respectively. Median operative blood loss was 600 ml. and 208 men (95%) had blood loss of 1,200 ml. or less. Median total hospital stay is now 2 days.

Radical perineal prostatectomy is safe. In our 220 patients there were no deaths and serious morbidity developed in 2%. The continence rate was 95% and 70% of a select group recovered potency.