Radical Prostatectomy in the Community: An Outcome Report Card

Roger Schultz
Urology of Virginia, Williamsburg, VA

Introduction:
Our community based practice has reviewed results following radical retropubic prostatectomy in patients treated over a four year period.
Methods:
137 men underwent retropubic prostatectomy by the same surgical team between the years 1998-2003. We retrospectively examined: Age, Race, Length of stay, Hospital charges, Pathology, Tumor stage, Pre/post PSA levels, Information regarding potency and urinary continence.
Results:
Average age was 62, of whom 76% were Caucasian, 17% African American, 7% Asian. Gleason scores 5-7 were noted in 87% pre-operatively, with 7% upgrading to Gleason 8-10 on the final pathology report. Only 4% tumor stage were T3-4. Average length of stay was 3.25 days with an average charge of ,112. There were four biochemical failures noted two or more years following surgery. Seventy seven percent had excellent erectile function, less than half of whom required a PDE-5 inhibitor. Within six months after surgery 66% reported no urianry leakage. Another 15% used one security pad daily. The remaining 19% reported severe and bothersome urinary incontinence within the first six months of surgery. After six months, this last group showed considerable improvement with only 5% reporting ongoing and severe incontinence (>2 pads and bothered).
Conclusions:
Our outcomes are comparable to those presented by major academic centers. We have studied our outcomes to provide a "report card" for our patients and the insurance carriers that increasingly seek this information.

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