Outpatient radical prostatectomy: Impact of standard perineal approach on patient outcome

Purpose: As managed care becomes more prevalent, urologists must critically evaluate the economic aspect of and patient satisfaction with urological p ractice patterns. We have previously reported the advantages of radical per ineal prostatectomy, which decreases hospitalization and morbidity, and pro vides a more rapid return to normal activity, translating into cost savings . We have since evaluated the satisfaction of patients who underwent outpat ient radical prostatectomy with and without laparoscopic pelvic lymph node dissection. Materials and Methods: We evaluated the charts of 250 consecutive patients who underwent outpatient radical perineal prostatectomy with less than 24 h ours of hospitalization from 1992 to 1997. Complications, pain management, blood transfusion, and bowel and urinary dysfunction were assessed. Validat ed quality of life questionnaires were mailed to 200 patients several month s postoperatively and a 62% response rate was achieved. Results: Mean followup in the series was 30 months. In the perioperative pe riod there were rectal perforation in less than 2% of patients, anastomotic stricture in 3%, perineal fistula in 0.4% and blood transfusion in 11%. So me problems with bowel movements immediately after the procedure, such as d iarrhea, constipation or soiled underwear, developed in 17% of patients, of whom up to 20% had had some bowel dysfunction before surgery. In the major ity bowel problems resolved in an average of 7.3 weeks. Persistent new onse t bowel trouble developed in 9 of the 124 patients (7%). The questionnaire demonstrated persistent significant urinary incontinence in 8 cases (7%). N erve sparing was attempted in 54 patients, including 22 (41%) who achieve e rection sufficient for vaginal penetration and are satisfied with sexual fu nction. Of the patients 17% reported problems after hospital discharge that were mostly related to Foley catheter management. Overall 94.8% of patient s were satisfied with treatment. Physical and social/family wellbeing appea red to be excellent according to the questionnaire. Only 12% of patients wo uld have preferred longer hospitalization. The preferred method of pain con trol was nonsteroidal antiinflammatory drugs. Conclusions: Radical perineal prostatectomy is a low morbidity alternative for localized prostate cancer. Outpatient radical perineal prostatectomy ma y be performed with good patient satisfaction and safety. There appear to b e few bowel problems after long-term followup.