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POTENCY, CONTINENCE AND COMPLICATION RATES IN 1,870 CONSECUTIVE RADICAL RETROPUBIC PROSTATECTOMIES
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COMPLICATIONS AFTER RADICAL PROSTATECTOMY
2. Steiner, M. S., Morton, R. A and Walsh, P. C.: Impact of anatomical radical prostatectomy on urinary continence. J. Urol., 1 4 5 512, 1991. 3. Walsh, P. C., Partin, A. W. and Epstein, J . I.: Cancer control and quality of life following anatomical radical retropubic prostatectomy: results a t 10 years. J. Urol., 1 5 2 1831, 1994. 4. Lerner, S. E., Blute, M. L., Lieber, M. M. and Zincke, H.: Morbidity of contemporary radical retropubic prostatectomy for localized prostate cancer. Oncology, 9 379, 1995. 5. Zincke, H., Oesterling, J. E., Blute, M. L., Bergstralh, E. J., Myers, R. P. and Barrett, D. M.: Long-term (15 years) results after radical prostatectomy for clinically localized (stage T2c or lower) prostate cancer. J . Urol., 1 5 2 1850, 1994. 6. Eastham, J. A,, Kattan, M. W., Rogers, E., Goad, J. R., Ohori, M., Boone, T. B. and Scardino, P. T.: Risk factors for urinary incontinence after radical prostatectomy. J . Urol., 1 5 6 1707, 1996. 7. Fowler, F. J., Jr., Barry, M. J., Lu-Yao, G., Roman, A., Wasson, J., and Wennberg, J . E.: Patient-reported complications and follow-up treatment after radical prostatectomy; the national Medicare experience: 1988-1990. Urology, 4 2 622, 1993. 8. Mettlin, C. J., Murphy, G. P., Sylvester, J., McKee, R. F., Morrow, M. and Winchester, D. P.: Results of hospital cancer registry surveys by the American College of Surgeons; outcomes of prostate cancer treatment by radical prostatectomy. Cancer, 8 0 1875, 1997. 9. Gaylis, F. D., Friedel, W. E. and Armas, 0. A,: Radical retropubic prostatectomy outcomes a t a community hospital. J. Urol., 1 5 9 167, 1998. 10. Catalona, W. J. and Dresner, S. M.: Nerve-sparing radical prostatectomy: extraprostatic tumor extension and preservation of erectile function. J . Urol., 1 3 4 1149, 1985. 11. Catalona, W. J. and Bigg, S. W.: Nerve-sparing radical prostatectomy: evaluation of results after 250 patients. J. Urol., 1 4 3 538, 1990. 12. Bigg, S. W., Kavoussi, L. R. and Catalona, W. J.: Role of nervesparing radical prostatectomy for clinical stage B2 prostate cancer. J . Urol., 144: 1420, 1990. 13. Catalona, W. J . and Basler, J. W.: Return of erections and urinary continence following nerve sparing radical retropubic prostatectomy. J . Urol., 1 5 0 905, 1993. 14. McCarthy, J. F. and Catalona, W. J.: Nerve-sparing radical retropubic prostatectomy. In: Textbook of Operative Urology. Edited by F. F. Marshall. Philadelphia: W. B. Saunders, chapt. 65, pp. 537-544, 1996.
15. Beahrs, 0. H., Henson, D. E., Hutter, R. V. P. and Kennedy,
B. J.: American Joint Committee on Cancer: Manual for Staging of Cancer, 4th ed. Philadelphia: J . B. Lippincott Co., 1992. 16. Catalona, W. J. and Smith, D. S.: 5-year tumor recurrence rates after anatomical radical retropubic prostatectomy for prostate cancer. J. Urol., 1 5 2 1837, 1994. 17. Armitage, P.: Tests for linear trends in proportions and frequencies. Biornetrics, 11: 379, 1955. 18. Hosmer, D. W., Jr. and Lemeshow, S.: Applied Logistic Regression. New York John Wiley & Sons, pp. 17-18 and 54, 1989. 19. Quinlan, D. M., Epstein, J. I. and Walsh, P. C.: Sexual function following radical prostatectomy: influence of preservation of neurovascular bundles. J . Urol., 1 4 5 998, 1991. 20. Haab, F., Yamaguchi, R. and Leach, G.: Postprostatectomy incontinence. Urol. Clin. N. Amer., 2 3 447, 1996. 21. Donellan, S. M., Duncan, H. J., MacGregor, R. J. and Russell, J . M.: Prospective assessment of incontinence after radical retropubic prostatectomy: objective and subjective analysis. Urology, 4 9 225, 1997. 22. Formenti, S. C., Lieskovsky, G., Simoneau, A. R., Skinner, D., Groshen, S., Chen, S. and Petrovich, Z.: Impact of moderate dose of postoperative radiation on urinary continence an potency in patients with prostate cancer treated with nerve sparing prostatectomy. J . Urol., 1 5 5 616, 1996. 23. Kavoussi, L. R., Myers, J . A. and Catalona, W. J.: Effect of temporary occlusion of hypogastric arteries on blood loss during radical retropubic prostatectomy. J . Urol., 1 4 6 362, 1991. 24. Bigg, S. W. and Catalona, W. J.: Prophylactic mini-dose heparin in patients undergoing radical retropubic prostatectomy: a prospective trial. Urology, 3 9 309, 1992. 25. Goodnough, L. T., Grishaber, J. E., Birkmeyer, J . D., Monk, T. G. and Catalona, W. J.: Efficacy and cost-effectiveness of autologous blood predeposit in patients undergoing radical prostatectomy procedures. Urology, 4 4 226, 1994. 26. Monk, T. G., Goodnough, L. T., Birkmeyer, M. E., Brecher, M. E. and Catalona, W. J.: Acute normovolemic hemodilution is a cost-effective alternative to preoperative autologous blood donation by patients undergoing radical retropubic prostatectomy. Transfusion, 3 5 559, 1995. 27. Monk, T. G., Goodnough, L. T., Brecher, M. E., Pulley, D. D., Colberg, J. W., Andriole, G. L. and Catalona, W. J.: Acute normovolemic hemodilution can replace preoperative autologous blood donation as a standard of care for autologous blood procurement in radical prostatectomy. Anesth. Analg., 8 5 953, 1997.
QUESTIONS AND RESPONSES Dr. C. A. Olsson. You reported some variation in the outcome following radical prostatectomy. Is experience of the surgeon a factor? Dr. W. J . Catalona. Yes, I think that surgeon experience is one of the most important factors affecting outcome after radical prostatectomy. Doctor Olsson. Is there a minimum number of surgeries that should be performed for a surgeon to be skilled? Doctor Catalona. It is difficult to make a categorical statement but I think a surgeon has to perform 100 prostatectomies before he/she begins to feel comfortable. I still learn something almost every day, after having performed more than 2,000 prostatectomies. Doctor Olsson. Is there a minimum number before continence becomes a reliable outcome? Doctor Catalona. Again, it is difficult to pick a number but I would say at least 100. The key to preserving continence is doing a good apical dissection without injuring the external sphincter mechanism. This is the most difficult part of the operation to learn. Even with the most experienced surgeons, 1to 2% of patients will have moderately severe incontinence and another 3 to 7% will have appreciable stress incontinence.
COMPLICATIONS AFTER RADICAL PROSTATECTOMY
2. Steiner, M. S., Morton, R. A and Walsh, P. C.: Impact of anatomical radical prostatectomy on urinary continence. J. Urol., 1 4 5 512, 1991. 3. Walsh, P. C., Partin, A. W. and Epstein, J . I.: Cancer control and quality of life following anatomical radical retropubic prostatectomy: results a t 10 years. J. Urol., 1 5 2 1831, 1994. 4. Lerner, S. E., Blute, M. L., Lieber, M. M. and Zincke, H.: Morbidity of contemporary radical retropubic prostatectomy for localized prostate cancer. Oncology, 9 379, 1995. 5. Zincke, H., Oesterling, J. E., Blute, M. L., Bergstralh, E. J., Myers, R. P. and Barrett, D. M.: Long-term (15 years) results after radical prostatectomy for clinically localized (stage T2c or lower) prostate cancer. J . Urol., 1 5 2 1850, 1994. 6. Eastham, J. A,, Kattan, M. W., Rogers, E., Goad, J. R., Ohori, M., Boone, T. B. and Scardino, P. T.: Risk factors for urinary incontinence after radical prostatectomy. J . Urol., 1 5 6 1707, 1996. 7. Fowler, F. J., Jr., Barry, M. J., Lu-Yao, G., Roman, A., Wasson, J., and Wennberg, J . E.: Patient-reported complications and follow-up treatment after radical prostatectomy; the national Medicare experience: 1988-1990. Urology, 4 2 622, 1993. 8. Mettlin, C. J., Murphy, G. P., Sylvester, J., McKee, R. F., Morrow, M. and Winchester, D. P.: Results of hospital cancer registry surveys by the American College of Surgeons; outcomes of prostate cancer treatment by radical prostatectomy. Cancer, 8 0 1875, 1997. 9. Gaylis, F. D., Friedel, W. E. and Armas, 0. A,: Radical retropubic prostatectomy outcomes a t a community hospital. J. Urol., 1 5 9 167, 1998. 10. Catalona, W. J. and Dresner, S. M.: Nerve-sparing radical prostatectomy: extraprostatic tumor extension and preservation of erectile function. J . Urol., 1 3 4 1149, 1985. 11. Catalona, W. J. and Bigg, S. W.: Nerve-sparing radical prostatectomy: evaluation of results after 250 patients. J. Urol., 1 4 3 538, 1990. 12. Bigg, S. W., Kavoussi, L. R. and Catalona, W. J.: Role of nervesparing radical prostatectomy for clinical stage B2 prostate cancer. J . Urol., 144: 1420, 1990. 13. Catalona, W. J . and Basler, J. W.: Return of erections and urinary continence following nerve sparing radical retropubic prostatectomy. J . Urol., 1 5 0 905, 1993. 14. McCarthy, J. F. and Catalona, W. J.: Nerve-sparing radical retropubic prostatectomy. In: Textbook of Operative Urology. Edited by F. F. Marshall. Philadelphia: W. B. Saunders, chapt. 65, pp. 537-544, 1996.
15. Beahrs, 0. H., Henson, D. E., Hutter, R. V. P. and Kennedy,
B. J.: American Joint Committee on Cancer: Manual for Staging of Cancer, 4th ed. Philadelphia: J . B. Lippincott Co., 1992. 16. Catalona, W. J. and Smith, D. S.: 5-year tumor recurrence rates after anatomical radical retropubic prostatectomy for prostate cancer. J. Urol., 1 5 2 1837, 1994. 17. Armitage, P.: Tests for linear trends in proportions and frequencies. Biornetrics, 11: 379, 1955. 18. Hosmer, D. W., Jr. and Lemeshow, S.: Applied Logistic Regression. New York John Wiley & Sons, pp. 17-18 and 54, 1989. 19. Quinlan, D. M., Epstein, J. I. and Walsh, P. C.: Sexual function following radical prostatectomy: influence of preservation of neurovascular bundles. J . Urol., 1 4 5 998, 1991. 20. Haab, F., Yamaguchi, R. and Leach, G.: Postprostatectomy incontinence. Urol. Clin. N. Amer., 2 3 447, 1996. 21. Donellan, S. M., Duncan, H. J., MacGregor, R. J. and Russell, J . M.: Prospective assessment of incontinence after radical retropubic prostatectomy: objective and subjective analysis. Urology, 4 9 225, 1997. 22. Formenti, S. C., Lieskovsky, G., Simoneau, A. R., Skinner, D., Groshen, S., Chen, S. and Petrovich, Z.: Impact of moderate dose of postoperative radiation on urinary continence an potency in patients with prostate cancer treated with nerve sparing prostatectomy. J . Urol., 1 5 5 616, 1996. 23. Kavoussi, L. R., Myers, J . A. and Catalona, W. J.: Effect of temporary occlusion of hypogastric arteries on blood loss during radical retropubic prostatectomy. J . Urol., 1 4 6 362, 1991. 24. Bigg, S. W. and Catalona, W. J.: Prophylactic mini-dose heparin in patients undergoing radical retropubic prostatectomy: a prospective trial. Urology, 3 9 309, 1992. 25. Goodnough, L. T., Grishaber, J. E., Birkmeyer, J . D., Monk, T. G. and Catalona, W. J.: Efficacy and cost-effectiveness of autologous blood predeposit in patients undergoing radical prostatectomy procedures. Urology, 4 4 226, 1994. 26. Monk, T. G., Goodnough, L. T., Birkmeyer, M. E., Brecher, M. E. and Catalona, W. J.: Acute normovolemic hemodilution is a cost-effective alternative to preoperative autologous blood donation by patients undergoing radical retropubic prostatectomy. Transfusion, 3 5 559, 1995. 27. Monk, T. G., Goodnough, L. T., Brecher, M. E., Pulley, D. D., Colberg, J. W., Andriole, G. L. and Catalona, W. J.: Acute normovolemic hemodilution can replace preoperative autologous blood donation as a standard of care for autologous blood procurement in radical prostatectomy. Anesth. Analg., 8 5 953, 1997.
QUESTIONS AND RESPONSES Dr. C. A. Olsson. You reported some variation in the outcome following radical prostatectomy. Is experience of the surgeon a factor? Dr. W. J . Catalona. Yes, I think that surgeon experience is one of the most important factors affecting outcome after radical prostatectomy. Doctor Olsson. Is there a minimum number of surgeries that should be performed for a surgeon to be skilled? Doctor Catalona. It is difficult to make a categorical statement but I think a surgeon has to perform 100 prostatectomies before he/she begins to feel comfortable. I still learn something almost every day, after having performed more than 2,000 prostatectomies. Doctor Olsson. Is there a minimum number before continence becomes a reliable outcome? Doctor Catalona. Again, it is difficult to pick a number but I would say at least 100. The key to preserving continence is doing a good apical dissection without injuring the external sphincter mechanism. This is the most difficult part of the operation to learn. Even with the most experienced surgeons, 1to 2% of patients will have moderately severe incontinence and another 3 to 7% will have appreciable stress incontinence.