Intraoperative and postoperative complications of radical retropubic prostatectomy in a consecutive series of 1,000 cases

Purpose: We critically examined the intraoperative and postoperative compli cations associated with radical retropubic prostatectomy in the modern era. Materials and Methods: Between April 18, 1994 and July 13, 2000, 1,000 men underwent radical retropubic prostatectomy performed by a single surgeon. T he whole inpatient hospital medical record of 909 patients, the outpatient charts of 955 and a self-administered patient survey completed by 679 were reviewed by 2 data managers not involved in surgical management or followup care. In all 1,000 cases at least 1 of the 3 data sources was reviewed. Results: Mean patient age was 60.3 years. In 73%, 99.8% and 95.7% of cases serum prostate specific antigen was 10 ng./ml. or less, disease was clinica l stage T1 or T2 and Gleason score was 7 or less, respectively, while 19.9% of pathological specimens showed positive margins. There were 8 intraopera tive complications (0.8%). All 5 rectal injuries and the single ureteral in jury were detected during the initial surgical procedure and repaired witho ut sequelae. Only 14 men (1.4%) had any other complications during hospital ization. Until postoperative day 30, 4 pulmonary emboli (0.4%) with or with out deep vein thrombosis and 5 myocardial infarctions (0.5%) developed. The re were no intraoperative or in-hospital postoperative deaths and only 1 po stoperative death secondary to myocardial infarction during the initial 30 days. Reexploration was done for hemorrhage and a disrupted anastomosis in 3 and 2 cases, respectively. Mean hospitalization was 2.3 days, 9.7% of pat ients required allogenic blood transfusion and 15 (1.5%) were rehospitalize d. Conclusions: Our series represents a rigorous assessment of the complicatio ns associated with radical retropubic prostatectomy. It shows that in the h ands of an experienced urological surgeon, this procedure is associated wit h minimal intraoperative and postoperative morbidity. Of the patients 98% h ad no intraoperative or postoperative complications. Our series enables app ropriate contemporary comparisons to be made with laparoscopic prostatectom y and radiation therapy. This outcomes analysis implies that radical retrop ubic prostatectomy cannot be assumed to have greater morbidity than radiati on therapy and it sets a high standard for those advocating laparoscopic ra dical prostatectomy.