S&T-18 PREOPERATIVE MEMBRANOUS URETHRAL LENGTH BECOMES PREDICT FACTOR FOR THE EARLY URINARY INCONTINENCE AFTER ROBOT ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY

Abstract

INTRODUCTION AND OBJECTIVES: Lymphoceles are common complications after pelvic lymph node dissection (PLND). Lymphatic vessels from the femoral canal are usually ligated or sealed with clips to avoid lymphoceles. However, data about the efficiency of this measure are lacking. Hence, we prospectively randomized patients (pts) undergoing extended PLND and robot-assisted radical prostatectomy (RARP) to compare the use of titan clips versus bipolar coagulation. METHODS: From July 2012 to July 2015, 220 consecutive pts undergoing PLND and RARP at our institution were enrolled in the study. Pts were prospectively randomized in two groups; In 110 pts titan clips were used to seal the lymphatic vessels during PLND (group A); in 110 pts only bipolar coagulation was used (group B). All pts underwent ultrasound examination 10 and 90 days after PLND. Lymphoceles were defined as any clear definable fluid collections in the pelvis. Pts with anastomotic insufficiency at cystography, routinely performed at postoperative day 4, were excluded from the trial. Lymphoceles were considered clinically relevant when causing pelvic pain, leg oedema, hydronephrosis, deep vein thrombosis, or infection/sepsis requiring any medical or surgical treatment. Groups A and B were compared using the Mann-Whitney and chi-square tests or Fisher’s exact test. RESULTS: Groups A and B were comparable regarding baseline data and intraand post-operative characteristics. There were no statistically significant differences between the two groups regarding mean operative time [241 43 min vs. 245 37 min; p1⁄40.211], median number of resected lymph nodes (LN) (19 vs. 18; p1⁄40.355), positive LN rates (16% vs. 19%; p1⁄40.596), positive surgical margins (13% vs. 16%; p1⁄40.233), complication rates (27% vs. 31%; p1⁄40.187) and mean length of stay [6 2 days vs. 7 3 days; p1⁄40.075]. Lymphoceles were detected in 105 of the total 220 pts (47%). 11/ 220 (5%) pts were symptomatic and required treatment. Groups A and B showed no significant difference regarding the overall incidence of lymphoceles [48% vs. 47%; p1⁄40.893], and in terms of clinically significant lymphoceles [5% vs. 4%; p1⁄40.725]. Both groups were also comparable regarding mean lymphocele volume [30 32 ml vs. 35 39; p1⁄40.566], lymphocele location (mono or bilateral) (p1⁄40.781), and detection at postoperative day 10 (95% vs. 98%; p1⁄40.499). CONCLUSIONS: Clipping or coagulating the lymphatic vessels do not to affect the incidence of postoperative lymphoceles as well as the risk of developing clinically significant lymphoceles after PLND and RARP.