1861 PELVIC LYMPHOCELES POST RADICAL PROSTATECTOMY; A SEARCH FOR ANSWERS

Abstract

You have accessJournal of UrologyProstate Cancer: Localized VIII1 Apr 20101861 PELVIC LYMPHOCELES POST RADICAL PROSTATECTOMY; A SEARCH FOR ANSWERS Wael Khoder, Matthias Trottmann, Alexander Buchner, Christian Stief, and Armin Becker Wael KhoderWael Khoder More articles by this author , Matthias TrottmannMatthias Trottmann More articles by this author , Alexander BuchnerAlexander Buchner More articles by this author , Christian StiefChristian Stief More articles by this author , and Armin BeckerArmin Becker More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1801AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Lymphoceles (LZ) are a rare but well described complication post radical prostatectomy (RP) which can cause serious postoperative complications. This is a report of the prevalence and pathophysiology of lymphoceles following radical prostatectomy (RP) in a community based study. METHODS The data has been retrospectively evaluated from 1163 RP patients who were operated in 67 clinics (January 2002 to January 2004). Postoperative ultrasound examination/CT was performed during hospitalization, 3 weeks rehabilitation and by complications. Furthermore, extensive search of PUBMED database has been performed and all previous experiences were used to explain and optimize the developed concepts. RESULTS LZ were identified in 304 patients (26%). Lymphadenectomy was done in 92% (1001 from 1086 Pat.), from which 28% had LZ (n=277) versus 14% without lymphadenectomy (12 from 85, p=0.007). Complications (Lower limbs oedema, pain, thrombosis, infection and compression of bladder) were observed in 9% (28 from 304) (2.4% of total patients) necessitating therapy. Risk factors for the development of lymphoceles were examined by univariate and multivariate analysis, and included patients age, sex, BMI, prostate volume, tumour TNM classification, number of removed lymph nodes, previous surgery/therapy, heparin prophylaxis, surgical instruments and pelvic lymphadenectomy. Univariate analysis showed lymphadenectomy as the only significant risk factor for the development of LZ post RP (p=0.007). When applying multivariate analyses using stepwise logistic regression, only this factor was associated with a significant risk for lymphoceles (odds ratio = 10.0, p=0.026). Adjusting for other factors, no other risk factor came close to being significant (p<0.05). All symptomatic LZ were successfully treated without further sequelae to the patients. CONCLUSIONS We conclude that the meticulous lymphadenectomy is the only significant factor contributing to the development of pelvic lymphoceles after RP. Possible prevention could be through adequate ligation of lymphatics or through prophylactic peritoneal marsupialisation during RP. LZ are curable complication resolving spontaneously and/or by surgical intervention. Munich, Germany© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e722-e723 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Wael Khoder More articles by this author Matthias Trottmann More articles by this author Alexander Buchner More articles by this author Christian Stief More articles by this author Armin Becker More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...