GU complications following radical prostatectomy

Context

The National Prostate Cancer Audit developed a validated measure of genitourinary (GU) complications following radical prostatectomy enabling a comparison of outcomes between NHS providers in England and Wales. Overall, 11% of men experienced at least one GU complication requiring a procedural/surgical intervention within two years following surgery in 2015, although a high level of variation was apparent.

Gloucestershire Hospitals NHS Foundation Trust was found to be outside the expected limits for the national mean rate following adjustment for age, comorbidities, cancer risk status and socio
economic deprivation – 28% of men experienced a GU complication within two years of follow-up. As a result, the trust was flagged as a potential outlier and the NPCA Outlier Process was
implemented. The Clinical Lead at Gloucestershire was formally notified and invited to review the trust results with support from the NPCA Clinical Leads. Patient-level data was provided.

Evaluation & diagnosis

Internal investigations carried out by the clinical lead and team verified the results and determined that an increased rate of urethral stricture post-operatively accounted for the increased
complication rate. Strictures occurred across all surgeons in the unit.

The lead clinician and trust team reviewed the entire process of surgery within the urology department to identify potential causative factors. Cross-departmental discussions were also carried
out to spread learning.

Improvement plan

On conclusion of the local investigation carried out by the trust, the following plan has been
implemented: 

• Changing the skin preparation used at surgery. 
• Shortening the time a catheter may be put on gentle traction during surgery.

Next on the improvement journey

Trust review of initial results indicate that the changes implemented have resulted in a reduction in strictures and thereby post-operative complication rate.

The Care Quality Commission’s hospital inspections utilise the results for Gloucestershire provided by the NPCA to support the National Clinical Audit Benchmarking initiative.

The NPCA will continue to provide validated results overtime to support benchmarking and quality improvement.