The continence status of patients with very large prostates after radical retropubic prostatectomy
Article published in Urologia Polska 2006/59/1.

authors

Dmitry Y. Pushkar ¹, Alexander V. Govorov ¹, John W. Kosko ²: ¹ MSMSU, Department of Urology, Moscow, Russia
² Newman Regional Health, Emporia KS, United States of America

keywords

prostate, prostate cancer, radical retropubic prostatectomy, continence status

summary

The aim of the study. The aim of our study was to assess the continence status of patients with very large glands (>100 cc) at 3, 6, 12 and 18 months after radical retropubic prostatectomy (RRP) and compare it with contemporaneous control patients with smaller prostates undergoing RRP at our institution.

Material and methods. 369 patients underwent radical retropubic prostatectomy after determining the prostate volume by means of transrectal ultrasound at the time of prostate biopsy. The continence status was assessed using a self-reported validated questionnaire at 3, 6, 12 and 18 months after operation. The patients were stratified into four groups according to their prostate volumes (Group I: <60 cc - 106 patients; Group II: 60-80 cc - 103 patients; Group III: 80-100 cc - 82 pts; Group IV: >100 cc - 78 patients).

Results. The continence rates of the four groups at 3, 6, 12 and 18 months postoperatively are shown in the table. Patients in group IV had significantly lower continence rates at 3, 6 and even 12 months postoperatively as compared with groups I, II and III (p<0,05). Interestingly, it took Group IV patients twice as long to achieve continence rates at 3 months as compared with those patients with prostate volume <80 cc. Among patients with prostates volume more than 100 cc, our results differ from some previously published data by showing a longer period of time to obtain the same continence rate as those with low prostate volumes.

Conclusions. Patients with large size prostates (>100 cc) need more time (up to 18 months) to have the same continence rate as those with smaller prostates after radical retropubic prostatectomy. While an enlarged prostate may contraindicate other potentially curative cancer treatments (external beam radiotherapy or brachytherapy), it is necessary to keep in mind the fact of postponed continence in discussing the treatment strategy with patients pre-operatively

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correspondence