What are the risks of surgery? How are they treated?

All surgical procedures have risks, and the common ones are infection, bleeding, pain, and anesthetic complications. Larger surgical procedures, which involve lengthier operative times and decreased postoperative mobility, have the risk of blood clots in the legs (deep venous thrombosis), pulmonary embolus, pneumonia, and stress-related stomach ulcers. Complications of radical prostatectomy include hernia^[1], significant bleeding requiring blood transfusion, infection, anesthetic-related complications, impotence, urinary incontinence, bladder neck contracture, deep venous thrombosis, rectal injury, and death.

Bleeding

In most cases, the blood loss is less than one pint (unit^[2]) of blood, but in about 5 to 10% of cases, a blood transfusion is required. The amount of blood loss tends to be lower with both laparoscopic and robotic-assisted radical prostatectomies, compared to open radical retropubic prostatectomy.

Infection

Several different types of infections can occur with this surgery. A skin infection (cellulitis) may occur at the incision, an abscess may occur under the skin or deep in the pelvis, or a urinary tract infection may occur. A skin infection at the incision typically presents with redness, swelling, tenderness, and occasionally, drainage at the incision. In the absence of pus, this usually can be treated successfully with oral antibiotics; rarely, intravenous antibiotics are indicated.

Abscesses are collections of pus and may occur just under the skin or deeper in the pelvis and require drainage. More superficial abscesses can be treated by opening the incision, draining the pus, and packing the wound with sterile gauze. The packing is continued until the area heals. If the abscess is in the pelvis, it can often be treated by placing a drain through the skin into the abscess and draining the pus. This is often done under X-ray guidance by an interventional radiologist.

Urinary tract infections result from the catheter, which drains the bladder during the healing process. The risk of a urinary tract infection increases with the number of days that the catheter is in place. Because most urologists leave the catheter in for 1 to 2 weeks after the surgery, your urologist may have you drop a urine sample off at the lab 2 to 3 days before the catheter is removed so that they can detect whether any bacteria is present and if so, treat the bacteria to prevent an infection after the catheter has been removed. Signs of a urinary tract infection include frequent urination, urgency and discomfort with urination, and sometimes a low-grade fever.

Anesthetic Complications

Most patients undergo general anesthesia^[3] for their radical prostatectomy; however, the procedure may be performed under spinal anesthesia. Epidural anesthesia^[4] may be used frequently to improve postoperative pain control and decrease intraoperative anesthetic requirements. The most commonly encountered side effects of general anesthesia are scratchy throat, nausea, and vomiting, but significant anesthetic complications are rare. With epidural catheters, potential side effects include lowering of the blood pressure and muscle blocks, which may affect movement of a leg.

• [1] A weakening in the muscle that leads to a bulge, often in the groin.
• [2] Term referring to a pint of blood.
• [3] Anesthesia which involves total loss of consciousness.
• [4] A special type of anesthesia whereby pain medications are placed through a catheter in the back, into the fluid that surrounds the spinal cord.