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PubMed2006

Laparoscopic radical prostatectomy: preliminary result of Thailand series.

OBJECTIVES: Several published series from Western countries have demonstrated that laparoscopic radical prostatectomy is a safe and feasible approach to the management of localized prostate cancer. The authors report the initial experience with the first 56 cases of laparoscopic radical prostatectomy. MATERIAL AND METHOD: Between June 2001 and November 2005, 56 patients with clinically localized prostate cancer underwent transperitoneal laparoscopic radical prostatectomy. Their mean (range) age was 64.98 (50-77) years, prostate specific antigen (PSA) level was 9.92 (2.1-33.8) ng/ml, and Gleason sum was 6.28 (3-8). RESULTS: Complete laparoscopic removal of the prostate was achieved in 47 cases and conversions to open surgery were needed in 9 cases. The mean (range) operating time was 350 (200- 750) min. and blood loss was 883 (200-2050) ml. The transfusion rate was 27.6%. Laparoscopic pelvic lymphadenectomy was done in 31 cases and all were negative. The positive surgical margin rate was 29.8%. There were 20 postoperative complications; catheter dislodged (2), urine leakage more than 2 weeks (5), peroneal nerve numbness (1), flank hematoma (1), pelvic collection (1), late recto-urethral fistula (1), anastomotic stricture (2), port site hernia (1), and inguinal hernia (6). Median catheter time was 7 (6-90) days. The complete continence rate at 3, 6 and 12 months were 27.7%, 55.9% and 72.2%. CONCLUSION: Laparoscopic radical prostatectomy is a demanding procedure that is a feasible option for the surgical treatment of localized prostate cancer Intraoperative results were improved once experience was gained. Some parameters of the present results, i.e. transfusion rate, positive surgical margin and continence rate were still inferior compared to those reported by other centers.

Aged↗
PubMed1991

[Radical prostatectomy and adjuvant endocrine treatment of prostatic cancer with lymphatic metastasis?].

The limits of curability of prostate cancer still have not been exactly defined. Data derived of randomized, retrospective comparative studies of patients with positive lymph nodes suggest an advantage in overall survival and cancer mortality if such tumors are treated by means of radical prostatectomy with immediate adjuvant endocrine therapy. An analysis of such publications, however, shows that the more favourable results are based on the unequal distribution of important prognostic factors. Several publications agree that adjuvant endocrine treatment in N+ disease leads to a prolongation of time to progression which is clinically and statistically significant. Up to now, however, a significant prolongation of survival has not been shown with early endocrine treatment. Patients have a choice between an initial short period of time until progression occurs if endocrine treatment is delayed. During this time they will be sexually potent. On the other hand, for the price of loss of potency and libido an initial longer period of time free of progression can be expected. It is unclear at this moment whether it makes sense to carry out a radical prostatectomy for palliative reasons. To come to a proper decision it is necessary to compare the risk of the untreated primary tumour and the risk of the radical prostatectomy in this situation. This comparison is very difficult and depends on factors which are not ready for comparison at this moment. Local progression under endocrine treatment is relatively rare and can usually be controlled by conservative means (TUR, radiotherapy). At this moment there are insufficient arguments to carry out palliative radical prostatectomy as a routine in lymph node positive patients.

Androgen Antagonists↗
PubMed1990

Patient selection for, results of, and impact on tumor resection of potency-sparing radical prostatectomy.

Our results show that by using the nerve-sparing radical retropubic prostatectomy, potency can be preserved in the majority of appropriately selected patients without compromising the adequacy of tumor excision. However, proper patient selection is important. Patients with focal, well-differentiated tumors, especially young patients with stage A or B1 tumors, are ideal candidates. In patients with more extensive and less well-differentiated tumors, there is a higher risk of incomplete tumor excision. Although we suspect that the adequacy of tumor excision is determined more by the extent of the tumor than by the technique of radical prostatectomy used, we believe that nerve-sparing surgery should be used with great caution, if at all, in patients with extensive or high-grade tumors. In these patients, microscopic extracapsular tumor extension is extremely common, can be impossible to detect at the time of operation, and is less likely to be adequately encompassed by nerve-sparing techniques. On the other hand, our current data provide little evidence that excision of the neurovascular bundles is beneficial. It is possible that more extensive resections will not materially alter the incidence of positive margins or cure rates. Finally, it might be argued that all forms of radical prostatectomy are inappropriate for patients with poorly differentiated clinical stage B2 prostate cancer for whom there are no really effective treatment options. We continue to recommend radical prostatectomy for these patients based on the finding that patients with clinical stage B2 disease who have organ-confined tumors can be expected to have excellent long-term disease-free survival rates similar to those of clinical stage B1 patients. In the remaining patients who are clinically understaged, the prospects for the minimal microscopic tumor remaining being controlled with adjunctive radiation therapy may be better than those of controlling the bulky primary tumor with radiation therapy alone. This hypothesis will need to be tested in a randomized clinical trial.

Erectile Dysfunction↗
PubMed1988

Radiation therapy as adjuvant treatment after radical prostatectomy.

Between 1977 and 1984, adjuvant radiation therapy was administered after radical prostatectomy to 71 patients at high risk for recurrence of carcinoma of the prostate. In 35 patients, tumor remained at the surgical margin (stage C2 disease) and/or the disease had invaded the seminal vesicles (stage C3). Thirty-six patients had microscopic metastases in the pelvic lymph nodes (stage D1a). Radiation therapy was administered only after full recovery from surgery, which included full recovery of continence. The average period between surgery and initiation of radiation therapy was 3 months. Serious or long-term complications attributable to irradiation occurred in 7% of the patients. Tumor recurred locally in only 2 patients. Five-year actuarial survival, disease-related survival, and disease-free survival for patients with stage C2 and C3 disease were 86%, 96%, and 80%, respectively. These survival values for patients with stage D1a disease were 74%, 90%, and 69%, respectively. Our results suggest a greater therapeutic benefit from radical prostatectomy and adjuvant radiation therapy than from radical prostatectomy alone for stages C2 and C3 disease or from radical prostatectomy alone or radiation therapy alone for stage D1a disease; however, the length of follow-up, number of patients treated, and problems in comparing our results with those from historical controls do not allow us to draw firm conclusions about the benefits of this combined therapy. Controlled, randomized studies clearly are required. The serum levels of prostate-specific antigen, but not prostatic acid phosphatase, were invariably elevated in patients at the time of clinical detection of disease recurrence and predicted recurrence up to 4 years before the event.(ABSTRACT TRUNCATED AT 250 WORDS)

Antigens, Neoplasm↗
PubMed1989

[Urinary continence in patients undergoing nerve sparing radical prostatectomy].

Recently, the morbidity of radical prostatectomy has been reduced by improvements in surgical techniques and greater understanding of pelvic anatomy. The nerve sparing technique has been considered to be a major contribution to this advance. In our study, urinary control was compared in 33 consecutive patients undergoing a radical retropubic prostatectomy. In 13 patients, a conventional radical prostatectomy was performed and in 20 subsequent patients, a nerve sparing operation was performed. The staff surgeons were the same throughout the study. The age of the patients and pathological stage of the tumor were not significantly different between the groups. The operative time was shorter and intraoperative blood loss was less both significantly in the nerve sparing group. In the conventional operated group, there was one patient with total incontinence and two with significant incontinence requiring absorbable pads. In the nerve sparing group, there were no patients having total incontinence and one had stress incontinence requiring absorbable pads. Urethral pressure profile was measured postoperatively in 17 in the nerve sparing group and in 7 in the conventional group. The maximum urethral pressure in the nerve sparing group was 31.5 cm H2O (SD = 5.4) and in the conventional group 23.2 cm H2O (SD = 5.7) with a significant difference between groups (p less than 0.01). The functional urethral length of the nerve sparing group was 16.7 mm (SD = 5.2) and in the conventional group 13.3 mm (SD = 3.7) with no significant difference between the groups. These results suggest that preservation of neurovascular bundles from the pelvic plexus during radical prostatectomy has no important role in postoperative urinary continence.

Aged↗
PubMed1987

Radical prostatectomy, preservation of sexual function, cancer control. The controversy.

In this article, I have addressed some of the important controversies regarding the safety and efficacy of radical prostatectomy with the preservation of sexual function: (1) How often is sexual function preserved? (2) Does preservation of sexual function interfere with cancer control? (3) Are there tricks to performing the operation? and (4) Who is a candidate? Overall, 72 per cent of patients are potent postoperatively. The probability of return of sexual function correlates with the age of the patient and the stage of the lesion. In addition, it appears that only one neurovascular bundle is necessary for the return of sexual function because 69 per cent of men who undergo wide excision of one neurovascular bundle are potent postoperatively. The question whether preservation of sexual function compromises the removal of tumor can be analyzed in several ways. On the basis of operative descriptions and the evaluation of whole-mount cross sections of prostates removed by standard radical perineal and radical retropubic techniques, it appears that the neurovascular bundles were not completely resected in the past using standard techniques. However, with knowledge of the location of these neurovascular bundles, they can now be excised more widely when necessary than was previously possible. Furthermore, evaluation of surgical margins of excision gave no indication that the nerve-sparing modification compromises the adequacy of the removal of cancer, which is determined primarily by the extent of the tumor rather than by the operative technique. However, controversy surrounding this procedure will not be settled until long-term follow-up data are available to determine whether the control of local disease and distant metastases is similar to that achieved with standard radical prostatectomies. To aid in this comparison, we have been careful not to use postoperative adjuvant hormonal or radiation therapy so that we will be able to evaluate the true impact of radical prostatectomy on the control of cancer. To preserve sexual function, a variety of fine points in surgical technique must be observed. These have been discussed in detail. It is my opinion that any patient who is a candidate for radical prostatectomy is a candidate for intra-operative assessment of the extent of tumor and the location of the neurovascular bundles. Based on this information, the surgeon can make an informed decision whether the neurovascular bundles can be safely preserved or excised widely with the specimen. In all surgical approaches to prostatic cancer, the primary goal must be excision of all tumor; preservation of sexual function should be of secondary concern.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMedDate not supplied

Preoperative mini-heparin, prostatectomy and clinical pulmonary thromboembolism.

From February 1973 through May 1977, a selected group of 131 patients undergoing prostatectomy were given preoperative mini-heparin 6--8 hours prior to surgery. There were 17 retropubic prostatectomies, 1 subtotal suprapubic prostatectomy and 113 transurethral prostatic resections. Patients ages ranged from 35 to 108 years. There were 109 cases of benign prostatic hyperplasia, 13 cases of adenocarcinoma of the prostate and 9 cases of benign prostatic hyperplasia with foci of adenocarcinoma. There was one death from massive pulmonary thromboembolism and one case of non-fatal pulmonary thromboembolism. A retrospective review of 416 prostatectomies performed during the same period of time at the same hospital, in which mini-heparin was not administered preoperatively, revealed only one case of non-fatal pulmonary thromboembolism. Our study indicates that this preoperative mini-heparin regime did not effectively reduce the morbidity and mortality associated with clinical postoperative thromboembolic phenomena. There were no important side effects, such as prolonged bleeding or drug intolerance, associated with the administration of preoperative mini-heparin.

Adenocarcinoma↗
PubMed1984

[Studies on prophylaxis and therapy of pivmecillinam against post-prostatectomy urinary tract infection].

Patients received pivmecillinam (PMPC) after prophylactic use of various antimicrobial chemotherapeutic agents following prostatectomy, and their clinical responses were assessed for effectiveness in the treatment and prevention of postoperative infection. The data were also analyzed to explore the relationship between bacterial isolates obtained during the postoperative course and the antimicrobial agents administered prophylactically against postoperative infection. Therapeutic effect of PMPC: Treatment of postoperative infections with PMPC was effective in 36 (53.7%) out of 67 patients who had undergone prostatectomy. Prophylactic effect of PMPC: The use of PMPC provided effective prevention of infection in 22 (64.7%) out of 34 patients from whom no bacterial pathogen had been isolated before postoperative antimicrobial chemotherapy. Therapeutic responses to PMPC, compared between different types of operative procedure: There was little or no difference in therapeutic effectiveness of PMPC against postoperative infection when compared between two types of operative procedure, transurethral prostatectomy and subcapsular removal of the prostate. Incidence and types of bacterial isolates following prophylactic chemotherapy with various agents after prostatectomy: Possibly because cephapirin (CEPR) and ticarcillin (TIPC) were mainly administered, alone or in combination, for prophylaxis against postoperative infection, Serratia and Pseudomonas were most frequently isolated. The findings offer suggestions as to the appropriate combination of antimicrobial agents to be used for prophylactic purposes. Effectiveness of PMPC in the presence or absence of a preoperative indwelling urethral catheter: The use of PMPC was more effective both in the treatment and prevention of postoperative infection in cases without preoperative indwelling urethral catheterization than in those with it.

Aged↗
PubMed1996

Molecular detection of prostate epithelial cells from the surgical field and peripheral circulation during radical prostatectomy.

PURPOSE: Prostate cancer progression despite organ confined pathological assessment has been reported in a variable number of men after radical retropubic prostatectomy. To study this phenomenon, we used the prostate specific antigen (PSA) reverse transcriptase-polymerase chain reaction assay. MATERIALS AND METHODS: We prospectively assayed the peripheral venous blood before, during and after surgical manipulation as well as the intraoperative field blood for PSA reverse transcriptase-polymerase chain reaction-positive cells in 22 men undergoing radical retropubic prostatectomy. RESULTS: PSA reverse transcriptase-polymerase chain reaction-positive cells were identified in 20 of the 22 operative field samples (91%) and 4 of 16 (25%) had evidence of intraoperative hematogenous dissemination (p = 0.046). No significant association was identified among Gleason score, pathological stage and the PSA reverse transcriptase-polymerase chain reaction result. CONCLUSIONS: Our results suggest that tumor cell spillage and less frequently hematogenous dissemination may be associated with operative manipulation of the prostate during radical retropubic prostatectomy and may potentially represent mechanisms of failure after radical retropubic prostatectomy.

Adenocarcinoma↗
PubMed1995

Evaluation of fluid absorption during laser prostatectomy by breath ethanol techniques.

PURPOSE: Laser prostatectomy has evolved as a less invasive method of relieving bladder outlet obstruction due to prostatic enlargement. The elimination of adenomatous tissue by laser induced coagulation necrosis theoretically avoids the sequelae of fluid absorption noted during traditional transurethral resection of the prostate. However, to our knowledge no accurate determination of fluid absorption during laser prostatectomy has been performed to date. MATERIALS AND METHODS: A technique previously described to determine the amount of irrigant absorbed during transurethral resection of the prostate measures breath ethanol levels using a standard alcohol breath analyzer during the procedure after a predetermined amount of ethanol is added to the irrigant fluid. This method was used in 4 men undergoing laser prostatectomy. RESULTS: All 4 subjects had ethanol levels of 0 throughout the operation, indicating that little or no irrigant fluid was absorbed. CONCLUSIONS: We demonstrated in a quantitative manner that fluid absorption during laser prostatectomy is almost nil and patients are, indeed, at no risk for the transurethral resection syndrome.

Absorption↗
PubMed1995

Ultrasensitive assay of prostate-specific antigen used for early detection of prostate cancer relapse and estimation of tumor-doubling time after radical prostatectomy.

We used an ultrasensitive prostate-specific antigen (PSA) assay with a detection limit of 0.02 microgram/L for long-term monitoring of PSA changes in 5 patients who were cured by radical prostatectomy and in 10 patients who had failed prostatectomies; 5 patients who underwent cystoprostatectomy were also evaluated with one sample after surgery. Relapse-free periods, determined on the basis of criteria designed specifically for the ultrasensitive assay or proposed for other currently available PSA assays, were calculated for the patients with failed prostatectomies. Tumor-doubling times were also calculated, postsurgery, according to a model that assumes exponential tumor growth over time. We found that prostate cancer relapse, on average, could be diagnosed 420 or 883 days earlier with the ultrasensitive assay than with assays having detection limits of 0.1 or 0.3 microgram/L, respectively. Tumor-doubling times, calculated after radical prostatectomy, ranged from 67 to 568 days among the 10 patients. We also present evidence that even more-sensitive PSA assays might be able to further reduce the relapse-free periods in approximately 50% of the prostate cancer patients who ultimately relapse.

Fluoroimmunoassay↗
PubMed1995

Extended experience with radical prostatectomy for clinical stage T3 prostate cancer: outcome and contemporary morbidity.

PURPOSE: Radical prostatectomy for clinical stage T3 prostate cancer has not been widely accepted due to the potential for incomplete excision of the local tumor and high incidence of lymph node metastases. In addition, contemporary morbidity is unknown. We report the long-term results in 812 patients with clinical stage T3 prostate cancer treated with radical prostatectomy. MATERIALS AND METHODS: Between 1966 and 1992, 812 patients with clinical stage T3 prostate cancer underwent radical prostatectomy of whom 479 (60%) received adjuvant therapy. RESULTS: Mean patient age was 65 years (range 40 to 78). Mean followup was 4.5 years (range up to 24). Disease was stage pT2c or less in 17% of patients, pT3a to c in 49% and node-positive in 33%. Of the primary tumors pathological Gleason score was 7 or greater in 62%. Crude and cancer-specific survival rates at 5, 10 and 15 years were 86%, 70% and 51%, and 90%, 80% and 69%, respectively. Operative morbidity paralleled that of patients with clinically localized disease (T2c or less). CONCLUSIONS: An excellent survival rate with low treatment related morbidity can be achieved by performing primary radical prostatectomy with adjuvant therapy in the patient with clinical stage T3 prostate cancer.

Adult↗
PubMed1994

Nuclear morphometry in automatic biopsy and radical prostatectomy specimens of prostatic carcinoma. A comparison.

Nuclear shape analysis performed upon prostatectomy specimens of prostatic carcinoma distinguished individual patients with good and poor prognoses. In order to be useful for prognosis assessment preoperatively, nuclear morphometry must be measured on needle biopsy specimens. We compared nuclear morphometry on automatic biopsy and radical prostatectomy specimens in 20 patients with prostatic carcinoma. Nuclear size was smaller (paired Student t test, P < .0001) in biopsy specimens (perimeter 17.0 +/- SD 4.9 microns, area 29.9 +/- 6.6 microns2) than in prostatectomy specimens (perimeter 24.6 +/- 4.4 microns, area 48.2 +/- 8.7 microns2). Nuclear shape was more abnormal in automatic biopsy specimens (nuclear roundness factor 82.0 +/- 18.8, ellipticity 90.5 +/- 27.7) than in surgical specimens (nuclear roundness factor 43.5 +/- 8.8, ellipticity 54.0 +/- 14.7) (P < .0001). Study of specimens obtained by automatic biopsy preoperatively and automatic biopsy of the prostatectomy specimens at various steps of processing revealed that nuclear swelling and rounding occurred after 2-24 hours of formalin fixation. Automatic prostate biopsies may more accurately reflect true nuclear morphometry and should be studied for preoperative prognosis prediction in patients with clinically localized prostatic carcinoma.

Biopsy↗
PubMed1995

The role of the physician in effecting change in hospital charge for radical prostatectomy.

BACKGROUND: Continuing effort is being made to provide the best medical care in a cost-effective manner, requiring an evaluation of factors that control charges. The number of cases of carcinoma of the prostate gland and the number of radical retropubic prostatectomies performed have increased in recent years, with an estimate of several hundred million dollars being spent annually on this procedure in the United States of America. Because physicians are reported to effect the majority of charges for a hospitalization, this study examines the influence of notification of the physician of hospital charges on the overall hospital charges for radical retropubic prostatectomy. STUDY DESIGN: Total hospital charge and duration per hospitalization were determined for all patients having radical prostatectomies performed at five community hospitals in Richmond, VA, between January 1991 and December 1993. Patients included 625 males diagnosed with carcinoma of the prostate gland undergoing radical prostatectomy by one of 20 urologists from several different private practice groups. Halfway into the time period studied, physicians were notified of data collection and of factors that seemed to have a role in hospital charges. Total hospital charges before and after physician notification were measured to determine whether or not physicians could effect hospital charges. RESULTS: Overall, hospital charges decreased significantly after notification of physicians in the study. The decline in total charges continued throughout the follow-up period. Duration of hospitalization decreased throughout the entire study period, while total charge per hospital day increased. CONCLUSIONS: Physician awareness of hospital charges for operative procedures and accompanying hospitalizations may influence the overall decrease in charges.

Adult↗
PubMed1995

Color Doppler flow imaging for deep venous thrombosis screening in patients undergoing pelvic lymphadenectomy and radical retropubic prostatectomy for prostatic carcinoma.

Patients undergoing pelvic lymphadenectomy and radical retropubic prostatectomy are traditionally considered to be at high risk for postoperative venous thromboembolic complications. A prospective deep venous thrombosis screening regimen was initiated at our medical center in 1990 following 2 cases of fatal pulmonary embolism that occurred after hospital discharge. During a 3-year period 245 consecutive patients undergoing radical retropubic prostatectomy for prostate cancer were screened postoperatively for lower extremity deep venous thrombosis using ultrasound duplex scanning with color Doppler flow imaging. The results were correlated only with the development of clinical deep venous thrombosis. No additional diagnostic modalities were used to confirm a normal venous system in asymptomatic patients. Venous thromboembolic complications were encountered in 9 of the 245 patients (3.6%). In 2 patients deep venous thrombosis was associated with nonfatal pulmonary embolism. Only 2 of the 9 cases of deep venous thrombosis were detected by color Doppler flow imaging screening. The striking decrease in the incidence of deep venous thrombosis following radical prostatectomy in the last decade and the low yield of screening at a single point in time may warrant reconsideration of the need for deep venous thrombosis screening among patients undergoing pelvic lymphadenectomy and radical retropubic prostatectomy for prostate cancer.

Adult↗
PubMed1994

DNA image cytometry of prostatic carcinoma: a comparison of needle core biopsy and subsequent prostatectomy specimens.

DNA ploidy has recently been identified as an objective prognostic factor in prostatic carcinoma. Although the diagnosis of prostatic carcinoma is increasingly being made with the use of needle core biopsies, the optimal method for the cytometric analysis of these specimens has yet to be determined. In addition, the degree to which the biopsy is representative of the subsequent prostatectomy specimen with respect to DNA heterogeneity has not been adequately addressed. In this study, image cytometric (ICM) DNA analysis was performed on tissue sections from 12 prostatic needle core biopsies and the results were compared with similar ICM analysis of the subsequent prostatectomy specimens. Multiple blocks (n = 48) of the prostatectomy specimens were utilized to prepare tissue sections and nuclear suspensions and each set of preparations were analyzed by ICM in a parallel comparison study. There was concordance of 0.80 in the classification of DNA diploid and aneuploid tumors by ICM analysis of tissue sections and nuclear suspensions from paraffin blocks. In all of the discordant cases, DNA aneuploid populations were identified by ICM analysis of tissue sections only. This is attributed to difficulties in obtaining a representative nuclear suspension from disaggregated paraffin-embedded prostatic tissue which often has a very desmoplastic stroma. ICM analysis of tissue sections seems to be an optimal method for DNA ploidy analysis of prostatic carcinoma and is well suited to small volume biopsy material. Determination of DNA ploidy status in prostatic biopsies was predictive of the subsequent prostatectomy specimens with a concordance of 0.92.

Aged↗
PubMed1994

[The role of radical prostatectomy for early stage prostate cancer].

Recent understanding of the periprostatic anatomy has led to an anatomical approach to radical prostatectomy, with reduced complications. Initially, a technique for management of the dorsal vein complex was developed that enabled the surgeon to perform a precise anatomic dissection at the apex of the prostate. Subsequently, the precise anatomy of the pelvic plexus and the branches that innervate the corpora cavernosa was studied. This led to the development of nerve-sparing radical prostatectomy. With the increasing chance of finding an early stage prostate cancer, radical prostatectomy has gained wide popularity even in Japan. On the other hand, the indications for radical prostatectomy are still controversial, especially for locally advanced (stages C) prostate cancer. Surgical staging is considered to be mandatory, because once pelvic lymph node metastases are identified, the prognosis is unfavorable irrespective of the mode of treatment. Minimally invasive approaches including laparoscopic pelvic lymphadenectomy have been developed for lymph node staging. The significance of the neoadjuvant hormonal treatment for locally advanced prostate cancer should be carefully discussed with regard to the long-term outcome.

Aged↗
PubMed1994

[Total prostatectomy for cancer. Mortality and morbidity. Apropos of 1288 operations. The ANFUC survey].

A retrospective survey of total prostatectomies performed for cancer was conducted by 30 urologists members of the French Association of Continuing Education (ANFUC). This survey was limited to the operation itself and perioperative complications observed during hospitalization. Urinary sequellae including incontinence and impotency were excluded and reported elsewhere. The follow-up has been considered insufficient to evaluate the effect of total prostatectomy on the cancer. Post-operative mortality was 1%, in agreement with previously reported series. Complications were analyzed in two categories, general and local. General complications were observed in 9.3% of the patients. The most frequent local complications was haemorrhage (14.7%) and lymphocele or lymphatic fistulas (8.5%). There were 28 perforations of the rectum (2.17%) which were treated with simple suture (n = 21) or rectal suture with an upstream stomy (n = 5). Local urinary complications were fistulas of the urethro-bladder anastomosis (n = 25) and narrowing of the anastomosis (n = 5). There were also 4 urethral strictures and 2 complete sections of the urethra which were recognized and repaired immediately. This first analysis of early complications of total prostatectomy shows that this operation involves only acceptable risks in terms of mortality and morbidity. Over the last few years, total prostatectomy has become a routine operation in urology.

Humans↗