However, it is a known occurrence and Dr. Colombo and associates in Milan, Italy report the clinical and functional outcomes of 109 of these patients in the December 2006 issue of the Journal of Urology.

Between 1999 and 2003, 109 men were identified as having had a previous surgical approach for bladder outlet obstruction from a group of 1,198 radical prostatectomy (RP) patients. Of these, 71 had a prior TURP or open simple prostatectomy with the incidental histological finding of CAP. RP was performed an average of 3.72 months later. In the remaining 38 patients, CaP was detected at a later date for a rise in PSA and they underwent RP an average of 26.7 months later.

A retrospective cross-sectional evaluation of surgical and functional outcomes was performed to compare the patients who had prior prostate surgery with 120 surgery naïve patients who underwent RP as the first and only prostatic surgery. Controls were matched for age, surgical period, serum PSA and clinical stage.

Clinical and functional outcomes suggested that overall technical difficulties did not vary in relation to the kind of pervious prostate surgery. Technical variations were often used during surgery, with 27% having an antegrade RP, and 11% a mixed antegrade and retrograde RP. The authors reported that preservation of the urethra and neurovascular bundles were the most difficult surgical steps in those with prior prostate surgery. In 28 patients (26%), the prostate capsule could not be removed en bloc due to inflammation. In 89 patients (81%) the Foley catheter was removed on postoperative day 11. Urinary leakage by cystograms was noted in 25%. Ten men required incision of a bladder neck contracture, at 12 months.

Pathologic staging was pT1-2 in 71%, pT3 in 30%. Capsular violation was noted in 32% and positive surgical margins in 26%. PSA was less than 0.04ng/ml in 92% of patients at the 12-month follow-up. Complete continence was achieved in 74%, and severe and mild incontinence were reported in 7% and 9%, respectively. Bilateral nerve sparing was performed in 18 (42%), and normal erectile function was found in 5 patients. Control patients had much less variation in surgical technique required, with superior urinary continence and return of erectile function.

While RP in men with a history of prior prostate surgery is technically feasible, experience is suggested to deal with the increased technical aspects of the operation.

Colombo R, Naspro R, Salonia A, Montorsi F, Raber M, Suardi N, Saccà A, Rigatti P

J Urol 2006;176(6):2459-63.

Written by Christopher P. Evans, MD, a Contributing Editor with UroToday.

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