Open Surgery Results

I continue to perform open radical prostatectomy in several situations. Firstly, where robotic prostatectomy is difficult to perform, such as a patient who has extensive adhesions. Robotic is also not the best option where the cancer is extremely extensive and tactile sensation is beneficial. Having performed over 3,500 open radical prostatectomies I have noticed that, to date, patients are more comfortable with the open approach.

I also currently perform many cases referred from other urologists with specifically difficult aspects of the case such as with failed radiotherapy or very advanced cancers.

It is important to me to present patient reported outcomes for my open radical prostatectomy series. I have done this frequently at national and international meetings, and these are often published.

My current results in open radical prostatectomy are:

  • Early stage cancer: Clearance 96%.
  • Overall cancer: Clearance 86%.
  • Cancer reoccurrence
  • T2 positive margin rate, 4%.

Surgical

  • Average blood loss, 350 mL - 1-2% transfusion rate.
  • Operating time: One and one half to two and a half hours.
  • Complications - major: 1%.
  • Complications - minor: 8%

Recovery

Leave hospital: Greater than 90% of patients leave within four days.

  • Catheter removal: 97% of patients have the catheter removed on day seven.
  • Readmission rate: 1%
  • Urethral stricture rate: 2%
  • Return to normal activities: 2 to 6 weeks.

Sexual function

Three factors have a strong influence on the recovery of erectile functioning following open radical prostatectomy; the age of the patient, the preoperative status of the sexual function and the surgical technique.

Erection recovery
Age Recovery Time
40 - 50 92% 12 - 18 months
50 - 60 80 - 85% 12 - 18 months
60 - 70 70% 12 - 18 months

In this review, the potency was defined as the ability to have intercourse on most occasions with or without the use of Viagra-like substances.

I have focussed on developing expertise in performing incremental nerve-sparing even in the presence of more advanced cancers. (British Journal of Urology International 2011, Ben Moore).

Urinary continence

Incontinence after surgery is a major concern shared by many patients. In Associate Professor Stricker's hands with his open series, 98-99% gain near perfect continence after open radical prostatectomy. Some patients due to unusual anatomy or physiology may never fully regain continence. The vast majority of patients regain their continence within three months and almost 80% have recovered within six weeks.

Current early continence outcomes for open radical prostatectomy
Time 0-1 precautionary pads
6 weeks 75%
3 months 90%
6 months 95%
12 months 98%
 

About Phillip

Phillip is the Chairman of the Department of Urology, St Vincent's Private Hospital and Clinic since 2003, and a Director of the St Vincent's Prostate Cancer Centre.

The Australian Prostate Cancer Research Centre in New South Wales recently appointed him as clinical director. He is also a member of the National Prostate Cancer Research Centre

Philip is currently the highest volume robotic surgeon in Australasia

He is perhaps best known for his work developing nerve sparing techniques to help patients maximise potency