Ambulatory radical retropubic prostatectomy

To review the experience of 40 consecutive patients who underwent radical retropubic prostatectomy and to determine if and how the procedure could be performed safely on an ambulatory basis.

Between June 20, 1994 and November 26, 1996, 40 consecutive men with clinically localized prostate carcinoma underwent radical retropubic prostatectomy. Retrospective data regarding the patient population, patient satisfaction, clinical outcome, and length of hospitalization were evaluated.

The average age for the patients was 62.6 years (range 44 to 75) with an average PSA of 10.44 ng/mL. Eighty percent (32 of 40) of the patients were discharged on postoperative day 1, 17.5% (7 of 40) were discharged on postoperative day 2, and 2.5% (1 of 40) were discharged on postoperative day 7. The average operative time was 89.5 minutes (range 65 to 135), measured from the time of incision to completion of closure. The organ-confined rate was 80% (32 of 40). The continence evaluated at 6 months was 90.9% (30 of 33). The potency at 4 months was 35% (10 of 28) and at 1 year was 55.6% (10 of 18). Postoperative complications were minimal, with 7.5% (3 of 40) bladder neck contractures and 2.5% (1 of 40) wound infections. Patient satisfaction assessed by questionnaires revealed that 90% (36 of 40) thought that the length of hospitalization was adequate and 97.5% (39 of 40) would choose to have the procedure again. A second series of 15 patients have also undergone radical retropubic prostatectomy utilizing a pelvic block to expedite discharge. Of these 15 procedures, 10 were performed on an ambulatory basis.

Radical retropubic prostatectomy can be performed expediently with the maintenance of patient satisfaction, continence rates, potency rates, recurrence rates, complication rates, and pathologic results. The advantage to such an approach is expedited patient discharge, cost savings to the medical system, and no alteration in patient recovery or clinical outcome, such as organ-confined rate, potency, and continence. In this series, the majority of patients were discharged on postoperative day 1. On the basis of this experience, we have performed the procedure on an outpatient basis, while maintaining the same high quality of care. To date, 10 patients have undergone ambulatory radical retropubic prostatectomy and were discharged the same day of surgery without complications.