Radical prostatectomy after previous prostate surgery: clinical and functional outcomes.
OBJECTIVE
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.


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 follow-ups, 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.
Colombo
Renzo
R
Department of Urology, University Vita-Salute San Raffaele, Scientific Institute Hospital San Raffaele, Via Olgettina 60, 20132 Milan, Italy. colombo.renzo@hsr.it
Naspro
Richard
R
Salonia
Andrea
A
Montorsi
Francesco
F
Raber
Marco
M
Suardi
Nazareno
N
Saccà
Antonino
A
Rigatti
Patrizio
P
D000368:Aged; D015897:Comorbidity; D007172:Erectile Dysfunction / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000601:surgery*; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000601:surgery*; D020127:Recovery of Function; D012086:Reoperation; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D001748:Urinary Bladder Neck Obstruction / Q000453:epidemiology / Q000601:surgery*; D014549:Urinary Incontinence / Q000453:epidemiology