Scand J Urol Nephrol26: 231-234, 1992
RADICAL RETROPUBIC PROSTATECTOMY: OUR EXPERIENCE WITH THE FIRST 54 PATIENTS Einar Servoll, Ole J. Halvorsen,' Svein Haukaas and Per A. Hraiszter From the Division of Urology, Department of Surgery and the 'Department of Pathology, Haukeland University Hospital, Bergen, Norway (Submitted December 13, 1990. Accepted for publication September 1 1 . 1991)
Scand J Urol Nephrol Downloaded from informahealthcare.com by UB Kiel on 11/09/14 For personal use only.
Abstract. Complications were analysed in a contemporary series of the first 54 retropubic radical prostatectomies performed for carcinoma of the prostate at our Institution. The postoperative morbidity was notable; three life threatening and ten minor complications occurred within the first 30 postoperative days. Thus, more than 1 year after the operations 7 patients had severe stress incontinence and 17 noticed minor degree of incontinence. Twenty-six per cent of the patients who claimed to be potent before surgery maintained potency. The operative time averaged 195 min and the demand for transfusions averaged 2.98 units per patient. Our experience in this early series of radical prostatectomy is that the operation cannot be done without notable postoperative morbidity.
Key words: radical retropublic prostatectomy, complications.
The treatment for organ-confined carcinoma of the prostate is controversial. Conservative management is favoured by many urologist especially in Europe (2, 4). On the other hand radical prostatectomy and radiotherapy are advocated by an increasing number of authors (1, 3, 13, 14). Comparison of the efficacy of different radical treatment modalities is hampered by lack of prospective randomised studies. The benefit of the treatment for a malignant disease should be balanced against the mortality and the morbidity caused by the treatment. The nerve-sparing radical retropubic prostatectomy introduced by Patrik Walsh has minimized the problem of urinary incontinence and impotence (1 5 , 16). We herein report our experience with the first 54 radical prostatectomies performed in the 5-year period 1984 to 1988. PATIENTS AND METHODS The patients were referred to the outpatient clinic and all had histological or cytological verification of carci-
noma of the prostate. There were 32 patients without obstructive symptoms but palpable disease, 7 patients with To-carcinoma and 15 patients with obstructive symptoms. The mean patient age was 61 years with a range of 49 to 71 years (Fig. 1). The preoperative work-up of the patients included a negative bone scan and the absence of enlarged lymph nodes on CAT scan and bilateral pedal lymphangiography with fine needle aspiration cytology. A11 patients were T-staged by digital rectal examination. A normal prostatic fraction of acid phosphatase was a prerequisite preoperatively. The clinical stage at presentation is shown in Fig. 2 . The patient data were collected primarily by chart review, the follow-up data being obtained by routine visits to the outpatient clinic. Pelvic lymph node dissection was limited to the internal iliac nodes and any other palpable enlarged nodes. The operation was terminated at that stage if lymph nodes were positive on frozen sections. The technique for removal of the prostate was essentially that described by Walsh (15). No routine antibiotics were administered. The patients stayed in hospital for 1 week and returned for catheter removal 2 weeks postoperatively. The patients were judged as completely dry, or slightly incontinent when leaking a few drops of urine on straining or severely incontinent when wearing 2 pads or more daily. The pathological specimens were fixed in formalin and sectioned into slices. A minimum of 6 tissue samples was selected for microscopy from areas macroscopically suspicious of carcinoma including samples from the prostatic capsule and seminal vesicles. Later on a refined technique was adopted; the surgical specimens were sectioned into slices of 5 mm thickness by a wholemount step section technique. One histological section covering the whole area of each slice was made and examined for carcinomatous infiltration and its relation to the prostatic capsule and seminal vesicle.
RESULTS Average operative time was 195 min (range 140 to 300 min). A mean value of 2.98 units of blood (range 0 to 14 units) was needed peroperatively per patient; 74% required 4 units or less Scand J Urol Nephrol26
232
E. Servo11 et al. No of pat.
No of pat. 5c
29LO
15-
30
Scand J Urol Nephrol Downloaded from informahealthcare.com by UB Kiel on 11/09/14 For personal use only.
20
10
n
RADICAL RETROPUBIC PROSTATECTOMY: OUR EXPERIENCE WITH THE FIRST 54 PATIENTS Einar Servoll, Ole J. Halvorsen,' Svein Haukaas and Per A. Hraiszter From the Division of Urology, Department of Surgery and the 'Department of Pathology, Haukeland University Hospital, Bergen, Norway (Submitted December 13, 1990. Accepted for publication September 1 1 . 1991)
Scand J Urol Nephrol Downloaded from informahealthcare.com by UB Kiel on 11/09/14 For personal use only.
Abstract. Complications were analysed in a contemporary series of the first 54 retropubic radical prostatectomies performed for carcinoma of the prostate at our Institution. The postoperative morbidity was notable; three life threatening and ten minor complications occurred within the first 30 postoperative days. Thus, more than 1 year after the operations 7 patients had severe stress incontinence and 17 noticed minor degree of incontinence. Twenty-six per cent of the patients who claimed to be potent before surgery maintained potency. The operative time averaged 195 min and the demand for transfusions averaged 2.98 units per patient. Our experience in this early series of radical prostatectomy is that the operation cannot be done without notable postoperative morbidity.
Key words: radical retropublic prostatectomy, complications.
The treatment for organ-confined carcinoma of the prostate is controversial. Conservative management is favoured by many urologist especially in Europe (2, 4). On the other hand radical prostatectomy and radiotherapy are advocated by an increasing number of authors (1, 3, 13, 14). Comparison of the efficacy of different radical treatment modalities is hampered by lack of prospective randomised studies. The benefit of the treatment for a malignant disease should be balanced against the mortality and the morbidity caused by the treatment. The nerve-sparing radical retropubic prostatectomy introduced by Patrik Walsh has minimized the problem of urinary incontinence and impotence (1 5 , 16). We herein report our experience with the first 54 radical prostatectomies performed in the 5-year period 1984 to 1988. PATIENTS AND METHODS The patients were referred to the outpatient clinic and all had histological or cytological verification of carci-
noma of the prostate. There were 32 patients without obstructive symptoms but palpable disease, 7 patients with To-carcinoma and 15 patients with obstructive symptoms. The mean patient age was 61 years with a range of 49 to 71 years (Fig. 1). The preoperative work-up of the patients included a negative bone scan and the absence of enlarged lymph nodes on CAT scan and bilateral pedal lymphangiography with fine needle aspiration cytology. A11 patients were T-staged by digital rectal examination. A normal prostatic fraction of acid phosphatase was a prerequisite preoperatively. The clinical stage at presentation is shown in Fig. 2 . The patient data were collected primarily by chart review, the follow-up data being obtained by routine visits to the outpatient clinic. Pelvic lymph node dissection was limited to the internal iliac nodes and any other palpable enlarged nodes. The operation was terminated at that stage if lymph nodes were positive on frozen sections. The technique for removal of the prostate was essentially that described by Walsh (15). No routine antibiotics were administered. The patients stayed in hospital for 1 week and returned for catheter removal 2 weeks postoperatively. The patients were judged as completely dry, or slightly incontinent when leaking a few drops of urine on straining or severely incontinent when wearing 2 pads or more daily. The pathological specimens were fixed in formalin and sectioned into slices. A minimum of 6 tissue samples was selected for microscopy from areas macroscopically suspicious of carcinoma including samples from the prostatic capsule and seminal vesicles. Later on a refined technique was adopted; the surgical specimens were sectioned into slices of 5 mm thickness by a wholemount step section technique. One histological section covering the whole area of each slice was made and examined for carcinomatous infiltration and its relation to the prostatic capsule and seminal vesicle.
RESULTS Average operative time was 195 min (range 140 to 300 min). A mean value of 2.98 units of blood (range 0 to 14 units) was needed peroperatively per patient; 74% required 4 units or less Scand J Urol Nephrol26
232
E. Servo11 et al. No of pat.
No of pat. 5c
29LO
15-
30
Scand J Urol Nephrol Downloaded from informahealthcare.com by UB Kiel on 11/09/14 For personal use only.
20
10
n
