Morbidity of Radical Perineal Prostatectomy Following Transurethral Resection of the Prostate

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Abstract
Radical prostatectomy in patients who have had prior transurethral resection of the prostate results in significant morbidity. From 1974-1982, 30 patients who had had previous transurethral resection of the prostate underwent radical perineal prostatectomy for localized prostatic cancer. Operative time and blood loss were similar to a group of patients who had not had prior transurethral resection of the prostate. Overall, 3 patients (10%) had total incontinence and 3 (10%) had stress incontinence requiring a pad or device. No patient undergoing radical prostatectomy less than 4 wk or more than 4 mo. after transurethral resection of the prostate had postoperative incontinence. When radical perineal prostatectomy was perfomed between 4 wk and 4 mo. after transurethral resection of the prostate the incidence of incontinence was 50%. Five patients experienced prolonged perineal urinary draniage, all but 1 of whom healed spontaneously. Of the 6 patients with incontinence 3 had prolonged drainage. No patient had a rectal injury and there was no operative mortality. Two patients died without cancer and 1 has evidence of disease recurrence. Radical prostatectomy may be performed safely with acceptable morbidity following transurethral resection of the prostate and that if 4 wk elapsed since resection it might be advantageous to wait 4 mo. before performing radical surgery to lessen the risk of incontinence.