Intraoperative and postoperative complications as well as functional outcomes in diabetic patients undergoing robotic-assisted laparoscopic radical prostatectomy
Vahudin Zugor, Apostolos P. Labanaris 1-2, Jorn H. Witt 1.
Department of Urology and Pediatric Urology – Prostate Center Northwest, St. Antonius Medical Center, Gronau, Germany.
Department of Urology, Interbalkan Medical Center, Thessaloniki, Greece.
Objectives: To assess the intraoperative and postoperative complications as well as functional outcomes in diabetic patients undergoing robotic-assisted laparoscopic radical prostatectomy (RARP).
Material & Methods: The records of 4000 men who underwent RARP from February 2006 to August 2012 were retrospectively reviewed. N=146 patients were indentified as having a clinical diagnosis of diabetes mellitus treated with biguanide or/and insulin prior to RARP. All patients were assessed for intraoperative as well as postoperative complications. Postoperative complications and re-interventions encountered up to 30 days postoperatively stratified by the Clavien classificationand were characterized as minor (Clavien’s grade I–IIIa) and major postoperative complications (Clavien’s grade IIIb-IVa). Hemorrhage was defined as greater than 500 ml blood loss during the operation. Furthermore the functional outcomes were evaluated as well. Continence status was defined as no pad use and potency status was defined as erections sufficient for penetration with or without phosphodiesterase inhibitors. Postoperative potency analysis was limited to patients who were potent preoperatively and who had undergone bilateral intrafacial nerve sparing.
Results: The time between the clinical diagnosis of diabetes was made and RARP was performed was unknown. Intraoperative complications observed were only hemorrhage and was encountered in N=1 case (0.6%). The Minor and major postoperative complications are listed in the Tables. N=36 (24.6%) cases had diabetes mellitus Type I and N=110 (75.4%) diabetes mellitus Type II. Patients under biguanide stopped treatment 3 days prior to surgery. The median age of the patients was 65.8 years (42-76), median prostate volume was 46.1 ml (18-142 ml) and median PSA value was 10.8 ng/ml (2.5-49.2 ng/ml). The Gleason biopsy score was Gleason 6 in N=81 cases (55.4%), Gleason 7 in 46 cases (31.5%), Gleason 8 in 11 cases (7.5%) and Gleason 9 in N=8 cases (5.6%). The clinical stage was thought to be confined in N=144 patients (98.6%) and locally extended in N=2 cases (1.4%). Lymph node dissection was performed in N=118 cases (80.8%). A bilateral intrafacial nerve sparing procedure was performed in N=37 cases (25.3%), the median operative time was 152 min (50-280 min) and the median blood loss was 151 ml (50-500-ml). The overall minor postoperative complication rate was 19.1% (N=28 cases) and overall major was 5.4% (N=8 cases). According to their preoperative IIEF score, N=74 of the patients (50.6%) had no signs of erectile dysfunction (IIEF ≥22) and only N=12 of these patients underwent nerve sparing. After a median follow-up period of 27.3 months (7-75 months), N=113 (77.3%) were continent and N=9 (75%) were potent.
Conclusions: Although RARP in this cohort of patients it is not free of complications and the functional outcomes are not optimal, taking into account the complications of diabetes itself, such as diabetic neuropathy and angiopathy, one would have expect worse outcomes.