title: Specific complications of radical perineal prostatectomy: a single institution study of more than 600 cases.
abstract: OBJECTIVE
  Although groups at several institutions have long experience with radical perineal prostatectomy (RPP), only few reports of larger series describe associated complications, mostly without reporting management options in detail. We analyzed specific perioperative and postoperative complications of the perineal approach and management strategies thereof.
  
  
  METHODS
  The medical records of 630 patients who underwent RPP between January 1997 and May 2003 were retrospectively reviewed in regard to complications and their management. Median followup was 8 months (range 1 to 68).
  
  
  RESULTS
  Major complications requiring open surgical intervention were noted in 11 patients (1.7%) for a total surgical revision rate of 2.4% (15 of 630). Two patients with persistent urinary fistula required fistula excision and closure. Two patients with a rectocutaneous fistula needed temporary diverting colostomy. Three patients with a combined urinary and fecal fistula were treated with protective colostomy, fistula excision and the interposition of a tunica vaginalis graft. No further morbidity was observed in these patients. In 7 patients a subvesical hematoma was drained surgically, including 3 mentioned in whom a hematoma expanded into the urethral anastomosis. Minor complications, which could be successfully managed conservatively or with endoscopic interventions only, developed in 124 patients for a total rate of 19.7%. In the long term 9% of the patients experienced postoperative de novo changes in stool habits after RPP but only 2.7% reported distressing anal sphincter incompetence.
  
  
  CONCLUSIONS
  RPP is a safe and reproducible procedure with low major complication and reintervention rates even in a training center setting with many involved surgeons. A subvesical hematoma should be revised early since it can be the origin of subsequent major complications.
authors.affiliation: Department of Urology, Johannes Gutenberg-University Medical School, Mainz, Germany. gillitze@mail.uni-mainz.de
authors.forename: Rolf
authors.initials: R
authors.lastname: Gillitzer
authors.forename: Sebastian W
authors.initials: SW
authors.lastname: Melchior
authors.forename: Christian
authors.initials: C
authors.lastname: Hampel
authors.forename: Christoph
authors.initials: C
authors.lastname: Wiesner
authors.forename: Jan
authors.initials: J
authors.lastname: Fichtner
authors.forename: Joachim W
authors.initials: JW
authors.lastname: ThUroff
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D006406:Hematoma / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010502:Perineum; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed