Perioperative morbidity of the extended radical perineal prostatectomy

Purpose: Perioperative morbidity is an essential indicator for the quality of an operative technique. This fact is especially important in radical pro statectomy since different treatment modalities may provide similar outcome in terms of local tumor control. Materials and Methods:The conventional type of radical perineal prostatecto my is associated with a significant percentage of positive surgical margins and was therefore substituted by a modified extended radical perineal pros tatectomy at our institution. This procedure which includes partial resecti on of the dorsal vein complex and extrafascial resection of the seminal ves icals was performed in 200 patients with clinical T1 to T3 prostate cancer. The medical records were retrospectively reviewed for perioperative morbid ity. Results:There was no perioperative mortality and only 7% of the patients ex perienced postoperative complications. Blood substitution was indicated in 14% of the patients and could be reduced to 4% in the last 50 patients, The reintervention rate was 2.5% including 3 patients in whom a rectocutaneous fistula had to be repaired. The suction drainage was removed in 92% patien ts within 5 days. The indwelling catheter stayed in place for less than 14 days in 89% of all patients and was removed as early as after 2-7 days in 9 2% of the last 50 patients. Anastomotic strictures were observed in 8 (5%) of 160 patients followed for more than 6 months. 874% of patients were cons idered continent after at least 6 months follow-up. However, pad use was re ported in 33.6%. Conclusion: The extended type of radical perineal prostatectomy provides ex cellent results in terms of perioperative morbidity, although a significant learning curve can be noted, which is indicated by blood substitution and duration of necessary catheter drainage. Since the rate of positive surgica l margins in pT3 tumors is low (21%) and iatrogenic positive margins in pT2 tumors are avoided, this type of prostatectomy should be performed in case a potency sparing procedure is not indicated. Copyright (C) 2001 S. Karger AG, Basel.