Postoperative bleeding following radical retropubic prostatectomy

Bleeding following radical prostatectomy is defined as significant postoperative hemorrhage requiring the acute transfusion of blood to support blood pressure. Of 1,350 consecutive radical prostatectomies 7 cases (0.5%) met this criterion. Of these patients 4 were explored for bleeding and 3 were managed expectantly. Mean blood product requirements for explored patients were comparable to those managed conservatively (13.8 versus 14.7). Total hospitalization days were less in patients who underwent a secondary operation (14.5 versus 21 days). In the 3 patients managed nonoperatively the pelvic hematoma drained through the anastomosis, resulting in symptomatic bladder neck contractures in all 3 and long-term incontinence in 2. Only 1 of the 4 patients explored (25%) experienced prolonged mild incontinence. These results suggest that patients requiring acute transfusions for hypotension following radical prostatectomy should be explored to evacuate the pelvic hematoma, and decrease the likelihood of bladder neck contracture and incontinence.