TY - JOUR
T1 - Radical Prostatectomy After Previous Prostate Surgery
T2 - Clinical and Functional Outcomes
AU - Colombo, Renzo
AU - Naspro, Richard
AU - Salonia, Andrea
AU - Montorsi, Francesco
AU - Raber, Marco
AU - Suardi, Nazareno
AU - Saccà, Antonino
AU - Rigatti, Patrizio
PY - 2006/12
Y1 - 2006/12
N2 - Purpose: Radical prostatectomy has progressively become an elective treatment for primary localized prostate cancer as well as for incidental or subsequent prostatic cancer after previous surgery for obstructive benign disease. This increased acceptance opens concerns about oncological and functional outcomes. Materials and Methods: Between July 1999 and August 2003, 109 patients underwent radical retropubic prostatectomy for prostate cancer as a second line approach after surgery for primary bladder outlet obstruction. Of these patients 88 had undergone previous transurethral resection of the prostate and 21 had undergone open prostatectomy. Incidental and delayed prostate cancer was detected in 71 and 38 cases, respectively. Perioperative and postoperative morbidity was evaluated in all patients, while postoperative functional outcomes were assessed by a subjective questionnaire in 43. Results: As a second surgery, radical retropubic prostatectomy was generally more complex technically and it resulted in longer operative time compared to radical surgery in naïve patients. In contrast, early and delayed postoperative morbidity increased moderately. Complete urinary continence was documented in 32 (74%) and 37 patients (86%) at the 6 and 12-month followups, respectively. In this patient cohort adequate erectile function was reported by 12%. Conclusions: Radical retropubic prostatectomy can be performed safely after previous prostate surgery for bladder outlet obstruction. However, a consistent surgical background in prostate surgery is needed to manage frequently unexpected difficulties. Candidates for second line prostate surgery should be informed that functional results are less predictable and satisfactory than those achieved after the same surgical approach in naïve patients.
AB - Purpose: Radical prostatectomy has progressively become an elective treatment for primary localized prostate cancer as well as for incidental or subsequent prostatic cancer after previous surgery for obstructive benign disease. This increased acceptance opens concerns about oncological and functional outcomes. Materials and Methods: Between July 1999 and August 2003, 109 patients underwent radical retropubic prostatectomy for prostate cancer as a second line approach after surgery for primary bladder outlet obstruction. Of these patients 88 had undergone previous transurethral resection of the prostate and 21 had undergone open prostatectomy. Incidental and delayed prostate cancer was detected in 71 and 38 cases, respectively. Perioperative and postoperative morbidity was evaluated in all patients, while postoperative functional outcomes were assessed by a subjective questionnaire in 43. Results: As a second surgery, radical retropubic prostatectomy was generally more complex technically and it resulted in longer operative time compared to radical surgery in naïve patients. In contrast, early and delayed postoperative morbidity increased moderately. Complete urinary continence was documented in 32 (74%) and 37 patients (86%) at the 6 and 12-month followups, respectively. In this patient cohort adequate erectile function was reported by 12%. Conclusions: Radical retropubic prostatectomy can be performed safely after previous prostate surgery for bladder outlet obstruction. However, a consistent surgical background in prostate surgery is needed to manage frequently unexpected difficulties. Candidates for second line prostate surgery should be informed that functional results are less predictable and satisfactory than those achieved after the same surgical approach in naïve patients.
KW - bladder neck obstruction
KW - impotence
KW - prostate
KW - prostatectomy
KW - urinary incontinence
UR - http://www.scopus.com/inward/record.url?scp=33750512119&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=33750512119&partnerID=8YFLogxK
U2 - 10.1016/j.juro.2006.07.140
DO - 10.1016/j.juro.2006.07.140
M3 - Article
C2 - 17085129
AN - SCOPUS:33750512119
VL - 176
SP - 2459
EP - 2463
JO - Journal of Urology
JF - Journal of Urology
SN - 0022-5347
IS - 6
ER -