Blood Loss during Radical Prostatectomy [RP] & outcomes.

[pjoshea13]

New German-Canadian study [1].

Of interest to me because of my RP experiense.

I donated the maximum 2 units of blood prior to surgery. My surgeon said that he would probably not need them. There was usually very little blood. This was not the case in the early days, when the surgeon was typically dealing with a sea of blood. But surgeons now know where the blood vessels are.

Except mine were somewhere else. So the two units were needed.

***

"About 6,279 consecutive patients with ORP {open RP} (2008-2015) and 2,720 patients with RALP {robotic-assisted laparoscopic RP} (2009-2015) were identified. Low, medium, and high BL {blood loss} was recorded in 31.4 vs. 45.7 vs. 22.9% for ORP and in 39.8 vs. 45.2 vs.15.0% for RALP.

"CaP patients who sustain higher BL during RP showed worse functional outcomes. High BL during ORP or RALP represented an independent predictor of erectile dysfunction and incontinence after surgery. However, the effect of high BL on the continence was temporarily and not present at 1 year after surgery in ORP and after 3 months in RALP."

The study didn't look at such things as treatment success, mean time to failure, mortality, etc.

I 'only' had "erectile dysfunction". The word dysfunction always seems to me to be an inadequate description of the problem - as though full functionality might one day be restored. Anyway, I am pleased to report, after 15 years, that "BL" did not adversely affect my survival.

-Patrick

[1] ncbi.nlm.nih.gov/pubmed/308...

Urol Oncol. 2019 Mar 8. pii: S1078-1439(19)30007-9. doi: 10.1016/j.urolonc.2019.01.006. [Epub ahead of print]

Impact of the estimated blood loss during radical prostatectomy on functional outcomes.

Preisser F1, Pompe RS2, Salomon G3, Rosenbaum C2, Graefen M3, Huland H3, Karakiewicz PI4, Tilki D5.

Author information

1

Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada.

2

Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.

3

Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.

4

Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada.

5

Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany. Electronic address: [e-mail].

Abstract

OBJECTIVE:

To investigate the effect of the estimated blood loss (BL) during radical prostatectomy (RP) for prostate cancer (CaP) on functional outcomes. We hypothesized that the estimated BL during RP for clinically localized CaP does not affect the functional outcomes.

MATERIALS AND METHODS:

Patients who underwent open RP (ORP) or robotic-assisted laparoscopic RP (RALP) were identified. BL was stratified into low, medium and high: ≤500 vs. >500 to 1000 vs. >1,000 ml for ORP and ≤150 vs. >150 to 400 vs. >400 ml for RALP. Multivariable logistic regression models (MLRM) tested the effect of BL on functional outcomes.

RESULTS:

About 6,279 consecutive patients with ORP (2008-2015) and 2,720 patients with RALP (2009-2015) were identified. Low, medium, and high BL was recorded in 31.4 vs. 45.7 vs. 22.9% for ORP and in 39.8 vs. 45.2 vs.15.0% for RALP. MLRM predicting potency revealed that high BL was an independent predictor for erectile dysfunction: Odds ratios (OR) were 0.50 (P = 0.03) and 0.52 (P = 0.04) for ORP and RALP, respectively. MRLM predicting continence in ORP revealed that high BL was an independent predictor for 7-days and mid-term: ORs were 0.80 (P = 0.04) and 0.66 (P = 0.002). Moreover, high BL was an independent predictor for 7-days continence in RALP: OR were 0.68 (P = 0.009).

CONCLUSION:

CaP patients who sustain higher BL during RP showed worse functional outcomes. High BL during ORP or RALP represented an independent predictor of erectile dysfunction and incontinence after surgery. However, the effect of high BL on the continence was temporarily and not present at 1 year after surgery in ORP and after 3 months in RALP.

Copyright © 2019. Published by Elsevier Inc.

KEYWORDS:

Blood loss; Erectile function; Functional outcome; Incontinence; Prostatectomy; Robotic-assisted prostatectomy

PMID: 30857988 DOI: 10.1016/j.urolonc.2019.01.006

[Hidden]

Interesting that I've never heard this topic discussed regarding RP surgery. I almost had the impression that the robot assisted RP was so precise and minimally invasive that it wasn't even an issue. BTW, I did contribute one unit of blood prior to my TURP surgery years ago. I got scolded that if I had done it any closer to the surgery it might have to have been rescheduled. My unit of blood wasn't needed. Sorry to hear of your erectile dysfunction following the surgery. Have you tried or considered trimix injections?

[pjoshea13 in reply to Hidden]

I haven't. Perhaps I should see Rebecca for Trimix needle phobia:

youtube.com/watch?v=zpzDzUG...(Not working as expected?)

-Patrick

[Hidden in reply to pjoshea13]

BTW, if you ever try to use trimix have 4 sudafed tablets on hand. You can slam these as an antidote to priapism.