Infected Lymphocele Research Articles

Antimicrobial Prophylaxis in Robot-Assisted Laparoscopic Radical Prostatectomy: A Systematic Review.

It remains unclear whether antibiotic prophylaxis (AP) should be recommended or discouraged in robot-assisted laparoscopic radical prostatectomy (RALP) for prostate cancer (PCa). The development of microbial resistance and side effects are risks of antibiotic use. This systematic review (SR) investigates the evidence base for AP in RALP. A systematic literature search was conducted until 12 January 2023, using Embase, MEDLINE, Cochrane CENTRAL, Cochrane CDSR (via Ovid) and CINAHL for studies reporting the effect of AP on postoperative infectious complications in RALP. Of 436 screened publications, 8 studies comprising 6378 RALP procedures met the inclusion criteria. There was no evidence of a difference in the rate and severity of infective complications within 30 days after RALP surgery between different AP protocols. No studies omitted AP. For patients who received AP, the overall occurrence of postoperative infectious complications varied between 0.6% and 6.6%. The reported urinary tract infection (UTI) rates varied from 0.16% (4/2500) to 8.9% (15/169). Wound infections were reported in 0.46% (4/865) to 1.12% (1/89). Sepsis/bacteraemia and hyperpyrexia were registered in 0.1% (1/1084) and 1.6% (5/317), respectively. Infected lymphoceles (iLC) rates were 0.9% (3 of 317) in a RALP cohort that included 88.6% pelvic lymph node dissections (PLND), and 3% (26 of 865) in a RALP cohort where all patients underwent PLND. Our findings underscore that AP is being administered in RALP procedures without scientifically proven evidence. Prospective studies that apply consistent and uniform criteria for measuring infectious complications and antibiotic-related side effects are needed to ensure the comparability of results and guidance on AP in RALP.

Wound infection in robotic-assisted radical prostatectomy compared with retropubic radical prostate surgery: A meta-analysis.

A meta-analysis investigation was executed to measure the wound infection (WI) in robotic-assisted radical prostatectomy (RRP) compared with retropubic radical prostate surgery (RRPS). A comprehensive literature investigation till February 2023 was applied, and 1197 interrelated investigations were reviewed. The 19 chosen investigations enclosed 107 153 individuals with prostate cancer (PC) at the starting point. 72 008 of them were utilising RRP, and 35 145 were utilising RRPS. Odds ratio (OR) in addition to 95% confidence intervals (CIs) was utilised to compute the value of the WI in RRP compared with RRPS by the dichotomous approaches and a fixed or random model. RRP had significantly lower surgical site wound infection (SSWI) (OR, 0.33; 95% CI, 0.21-0.52, P < .001) and infected lymphoceles (ILs) (OR, 0.45; 95% CI, 0.22-0.92, P = .03) compared with RRPS in individuals with PC. RRP had significantly lower SSWI and ILs compared with RRPS in individuals with PC. However, care must be exercised when dealing with its values because of the low sample size of some of the nominated investigations for the meta-analysis.

Phase II study of the efficacy of retifanlimab (Rf) (INCMGA00012) in penile squamous cell carcinoma (PSqCC): ORPHEUS final analysis.

5043 Background: PSqCC is a rare tumor with poor prognosis. The standard of care for advanced disease (AD) has been palliative platinum-based chemotherapy (CT). Most PSqCC patients (pts) have high levels of programmed death-ligand 1 (PD-L1). ORPHEUS has evaluated the efficacy and safety of Rf –a PD-1 antagonist– in pts with unresectable locally advanced or metastatic PSqCC. Methods: ORPHEUS (NCT04231981) is an international, multicenter, open-label, single-arm phase II trial. The study enrolled pts aged ≥18 years with locally advanced or metastatic PSqCC who had not received any previous treatment with PD-1 or PD-L1/2 agents. Pts received Rf 500 mg intravenously on day 1 of each 28-day cycle until progressive disease, unacceptable toxicity, discontinuation or death. The primary endpoint was investigator-assessed objective response rate (ORR) as per RECIST v.1.1. Secondary endpoints included clinical benefit rate, progression-free survival (PFS), duration of response (DoR), time to response (TTR), disease control rate (DCR), overall survival (OS) and safety evaluated as per NCI-CTCAE 5.0. The design was planned to attain an 80% power at 5% one-sided α level (H0: ORR≤5%; HA: ORR≥25%). Results: Between Jul 7, 2020, and Aug 26, 2021, 18 men were enrolled at 8 sites from Italy and Spain. Median age was 64.2 years (range 42-81),13 (72.2%) pts had an AD at first diagnosis, 15 (83.3%) had a previous surgical procedure for penile cancer (lymphadenectomy in 7 pts), 10 (55.6%) had previously received platinum-based CT (TPF/TIP in 8 pts) and 7 (38.9%) were naïve to AD treatment. At data cutoff (Aug 26, 2022), with a median follow-up of 7.2 months, no pts remained on therapy. ORR (3 partial responses) was 16.7% (95% CI 5.8%-39.2%) with a median DoR and TTR of 3.3 (range 1.8-8.5) and 1.9 (range 1.7-2.4) months, respectively. DCR was (33.3%) (1 stable disease ≥ 6 months). Median PFS was 2.0 months (95% CI 1.6-3.3) and median OS with 17 events was 7.2 months (95% CI 3.0-9.8). Most common non-hematological treatment emergent adverse events (TEAEs) of any grade (G) were fatigue (27.8%; 5.6% G≥3), cellulitis, groin infection and Pseudomonas infection (11.1%; 5.6% G≥3), respectively. Treatment related (TR) TEAEs were fatigue (22.2%; 5.6% G≥3), rash (5.6%; 0% G≥3) and decreased appetite (5.6% G≥3). Anemia (11.1%; 0% G≥3) was the most frequent hematological TEAE. Serious unrelated TEAEs occurred in 5 pts (27.8%). Two (11.1%) pts discontinued treatment due to unrelated non-hematological TEAEs; 1 case of infected lymphocele (G3) and 1 case of skin neoplasm bleeding (G3). No TR deaths were reported. Conclusions: Rf in monotherapy showed signals of clinical activity in advanced or metastatic PSqCC pts. Safety profile was consistent with previous data. These results along with identification of suitable biomarkers could help to develop novel immunotherapy combination strategies in this orphan genitourinary tumor. Clinical trial information: NCT04231981 .

Effectiveness of endoscopic ultrasound-guided drainage procedure for symptomatic lymphocele.

A 65-year-old Japanese woman was admitted to our hospital with complaints of abdominal pain and a fever of 39.0 °C. Computed tomography (CT) revealed an infected lymphocele after surgery for ovarian cancer. Endoscopic ultrasound-guided lymphocele drainage (EUS-LD) was planned while avoiding free space between the colon and lymphocele using a convex EUS scope ([Fig. 1]).

First-in-patient study of OTL78 for intraoperative fluorescence imaging of prostate-specific membrane antigen-positive prostate cancer: a single-arm, phase 2a, feasibility trial

Targeted real-time imaging during robot-assisted radical prostatectomy provides information on the localisation and extent of prostate cancer. We assessed the safety and feasibility of the prostate-specific membrane antigen (PSMA)-targeted fluorescent tracer OTL78 in patients with prostate cancer. In this single-arm, phase 2a, feasibility trial with an adaptive design was carried out in The Netherlands Cancer Institute, Netherlands. Male patients aged 18 years or older, with PSMA PET-avid prostate cancer with an International Society of Urological Pathology (ISUP) grade group of 2 or more, who were scheduled to undergo robot-assisted radical prostatectomy with or without extended pelvic lymph node dissection were eligible. All patients had a robot-assisted radical prostatectomy using OTL78. Based on timing and dose, patients received a single intravenous infusion of OTL78 (0·06 mg/kg 1-2 h before surgery [dose cohort 1], 0·03 mg/kg 1-2 h before surgery [dose cohort 2], or 0·03 mg/kg 24 h before surgery [dose cohort 3]). The primary outcomes, assessed in all enrolled patients, were safety and pharmacokinetics of OTL78. This study is completed and is registered in the European Trial Database, 2019-002393-31, and the International Clinical Trials Registry Platform, NL8552, and is completed. Between June 29, 2020, and April 1, 2021, 19 patients were screened for eligibility, 18 of whom were enrolled. The median age was 69 years (IQR 64-70) and median prostate-specific antigen concentration was 15 ng/mL (IQR 9·3-22·0). In 16 (89%) of 18 patients, robot-assisted radical prostatectomy was accompanied by an extended pelvic lymph node dissection. Three serious adverse events occurred in one (6%) patient: an infected lymphocele, a urosepsis, and an intraperitoneal haemorrhage. These adverse events were considered unrelated to the administration of OTL78 or intraoperative fluorescence imaging. No patient died, required a dose reduction, or required discontinuation due to drug-related toxicity. The dose-normalised maximum serum concentration (Cmax/dose) in patients was 84·1 ng/mL/mg for the 0·03 mg/kg dose and 79·6 ng/mL/mg for the 0·06 mg/kg dose, the half-life was 5·1 h for the 0·03 mg/kg dose and 4·7 h for the 0·06 mg/kg dose, the volume of distribution was 22·9 L for the 0·03 mg/kg dose and 19·5 L for the 0·06 mg/kg dose, and the clearance was 3·1 L/h for the 0·03 mg/kg dose and 3·0 L/h for the 0·06 mg/kg dose. This first-in-patient study showed that OTL78 was well tolerated and had the potential to improve prostate cancer detection. Optimal dosing was 0·03 mg/kg, 24 h preoperatively. PSMA-directed fluorescence imaging allowed real-time identification of visually occult prostate cancer and might help to achieve complete oncological resections. On Target Laboratories.

MP67-16 SURGICAL OUTCOMES IN PATIENTS RECEIVING NEOADJUVANT VACCINE THERAPY (PROSTVAC) PRIOR TO RADICAL PROSTATECTOMY: A PHASE II EXPERIENCE

You have accessJournal of UrologyCME1 Apr 2023MP67-16 SURGICAL OUTCOMES IN PATIENTS RECEIVING NEOADJUVANT VACCINE THERAPY (PROSTVAC) PRIOR TO RADICAL PROSTATECTOMY: A PHASE II EXPERIENCE Zoe Blake, Daniel Nemirovsky, Alexander Kenigsberg, Neil Mendhiratta, Jacob Enders, Michael Rothberg, Daniel Nethala, Baris Turkbey, Bradford Wood, Sandeep Gurram, Howard Parnes, James Gulley, and Peter Pinto Zoe BlakeZoe Blake More articles by this author , Daniel NemirovskyDaniel Nemirovsky More articles by this author , Alexander KenigsbergAlexander Kenigsberg More articles by this author , Neil MendhirattaNeil Mendhiratta More articles by this author , Jacob EndersJacob Enders More articles by this author , Michael RothbergMichael Rothberg More articles by this author , Daniel NethalaDaniel Nethala More articles by this author , Baris TurkbeyBaris Turkbey More articles by this author , Bradford WoodBradford Wood More articles by this author , Sandeep GurramSandeep Gurram More articles by this author , Howard ParnesHoward Parnes More articles by this author , James GulleyJames Gulley More articles by this author , and Peter PintoPeter Pinto More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003330.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: PROSTVAC is a therapeutic cancer vaccine designed to activate T cells specific against prostate-specific antigen (PSA). Previous trials have shown PROSTVAC to be safe and capable of modulating immune responses in patients with localized prostate cancer (PCa). We aim to examine the surgical safety and feasibility outcomes of patients in a phase II trial (NCT02153918) investigating the neoadjuvant use of this vaccine therapy in patients with localized PCa. METHODS: An open-label, phase II study of neoadjuvant PROSTVAC vaccine enrolled patients with histopathologically confirmed localized PCa who were surgical candidates for radical prostatectomy (RP). Patients received recombinant vaccinia (rV)-PSA(L155)-TRICOM (PROSTVAC) as a priming vaccination, followed by monthly boosts on weeks 5, 9 and 13 with recombinant fowlpox (rF)-PROSTVAC. The boosting schedule was amended mid-trial to weeks 3, 5 and 9 to allow for earlier surgeries. After completing the vaccination series, patients underwent RP at week 10. Final follow-up safety evaluation was performed 12–15 months postoperatively. RESULTS: Between 2014-2016, 26 of 27 enrolled patients went on to receive RP. On pre-RP biopsy, 12/26 (46.2%) of patients had Gleason grade group (GG) 1-2, and 14/26 (53.8%) of patients had GG 3-5 (Table 1). Two patients (7.7%) were upgraded, and five (19.2%) downgraded on final pathology. Rates of adverse features at RP are shown in Table 2. The most common adverse event (AE) was a self-limited injection-site reaction (28 events in 18 patients), and no serious AEs or toxicities>grade 2 were attributed to PROSTVAC. However, two grade 3 serious AEs occurred: an infected lymphocele and a thromboembolic event, both attributed to surgery. CONCLUSIONS: PROSTVAC was well tolerated and demonstrated the feasibility of neoadjuvant vaccination strategies for localized PCa. Further studies will be needed to elucidate the effectiveness of this vaccine therapy on short and long-term oncologic outcomes. Source of Funding: NIH intramural research program © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e949 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Zoe Blake More articles by this author Daniel Nemirovsky More articles by this author Alexander Kenigsberg More articles by this author Neil Mendhiratta More articles by this author Jacob Enders More articles by this author Michael Rothberg More articles by this author Daniel Nethala More articles by this author Baris Turkbey More articles by this author Bradford Wood More articles by this author Sandeep Gurram More articles by this author Howard Parnes More articles by this author James Gulley More articles by this author Peter Pinto More articles by this author Expand All Advertisement PDF downloadLoading ...

MP61-11 RETZIUS-SPARING ROBOT-ASSISTED RADICAL PROSTATECTOMY AFTER PREVIOUS TRANS-URETHRAL RESECTION OF THE PROSTATE: ASSESSMENT OF FUNCTIONAL AND ONCOLOGICAL OUTCOMES

You have accessJournal of UrologyCME1 Apr 2023MP61-11 RETZIUS-SPARING ROBOT-ASSISTED RADICAL PROSTATECTOMY AFTER PREVIOUS TRANS-URETHRAL RESECTION OF THE PROSTATE: ASSESSMENT OF FUNCTIONAL AND ONCOLOGICAL OUTCOMES Stefano Tappero, Enrico Vecchio, Erika Palagonia, Giorgia Granelli, Marco Martiriggiano, Ofir Maltzman, Alberto Olivero, Silvia Secco, Aldo Massimo Bocciardi, Antonio Galfano, and Paolo Dell'oglio Stefano TapperoStefano Tappero More articles by this author , Enrico VecchioEnrico Vecchio More articles by this author , Erika PalagoniaErika Palagonia More articles by this author , Giorgia GranelliGiorgia Granelli More articles by this author , Marco MartiriggianoMarco Martiriggiano More articles by this author , Ofir MaltzmanOfir Maltzman More articles by this author , Alberto OliveroAlberto Olivero More articles by this author , Silvia SeccoSilvia Secco More articles by this author , Aldo Massimo BocciardiAldo Massimo Bocciardi More articles by this author , Antonio GalfanoAntonio Galfano More articles by this author , and Paolo Dell'oglioPaolo Dell'oglio More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003319.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To date, no data exist concerning functional and oncological outcomes of Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) in patients previously treated with trans-urethral resection of the prostate (p-TURP) for benign prostate obstruction. The current study aimed to address the impact of p-TURP on immediate and 12-months urinary continence recovery (UCR), as well as perioperative outcomes and surgical margins after RS-RARP. METHODS: Patients treated with RS-RARP for prostate cancer at a single high-volume European institution were identified and stratified according to p-TURP. Intraoperative and postoperative complications were reported according to EAU guidelines standardized methodology. Univariable and multivariable logistic, Poisson log-linear and Cox regression models were performed. RESULTS: Of 1,386 RS-RARP patients, 99 (7%) had history of p-TURP. According to EAU intraoperative adverse events classification (EAUiaiC), the most common intraoperative complications were EAUiaiC grade 1 (n=26/31, 84%). The most common postoperative complications were Clavien-Dindo grade 2 (n=67/174, 39%), and the most common reason of readmission was infected lymphocele (n=8/16, 50%). Between p-TURP and no-TURP patients no differences were detected in terms of rates of intraoperative complications (2 vs 2%), in-hospital postoperative complications (12 vs 11%), and readmissions (1 vs 1%; all p values≥0.8). At catheter removal, the rates of immediate UCR were 40 vs 67% in p-TURP vs no-TURP patients (p<0.001). At 12 months from RS-RARP, the rates of UCR were 68 vs 94% in p-TURP vs no-TURP patients (p<0.001). At multivariable logistic and Cox regression models, p-TURP was independently associated, respectively, with lower immediate (odds ratio [OR]: 0.32, p<0.001) and 12-months UCR (hazard ratio: 0.54, p<0.001). At multivariable Poisson analyses, p-TURP predicted longer operative time (rate ratio: 1.08, p<0.001) but not longer length of stay or time to catheter removal (p values>0.05). Positive surgical margins rates were 23 vs 17% in p-TURP vs no-TURP patients (p=0.1), which translated in a non significant multivariable OR of 1.14 (p=0.58). CONCLUSIONS: RS-RARP in patients with history of TURP for BPO may be longer and associated with worse urinary continence recovery both at bladder catheter removal and at subsequent time-points. In the current series, p-TURP patients harbored low complication rates, and surgical margins rates comparable to their no-TURP counterparts. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e856 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Stefano Tappero More articles by this author Enrico Vecchio More articles by this author Erika Palagonia More articles by this author Giorgia Granelli More articles by this author Marco Martiriggiano More articles by this author Ofir Maltzman More articles by this author Alberto Olivero More articles by this author Silvia Secco More articles by this author Aldo Massimo Bocciardi More articles by this author Antonio Galfano More articles by this author Paolo Dell'oglio More articles by this author Expand All Advertisement PDF downloadLoading ...

Robot-Assisted Treatment of Symptomatic Lymphocele Postradical Prostatectomy and Lymphadenectomy in the Era or Robotic Surgery: Narrative Review.

Background: Pelvic lymphnode dissection (PLND) is an integral part of surgical treatment for localized intermediate and high-risk prostate cancer. The most common complication of PLND is lymphocele formation. In the majority of cases the development of lymphoceles is clinically asymptomatic but in case of symptomatic/infected lymphocele an active treatment is required. The aim of this article is to analyse the current evidence on the treatment of symptomatic/infected lymphocele trough robotic approach. Materials and Methods: The search was applied to PubMed, EMBASE, and Cochrane databases with following terms: "lymphocele", "symptomatic", "infected", "robot-assisted AND radical prostatectomy", "robot-assisted", "treatment". Results: The search identified three series focusing on the treatment by robot-assisted approach of symptomatic and/or infected lymphocele. The main and most frequent reason for performing the robotic treatment was an infected lymphocele, the median time from robot-assisted radical prostatectomy and PLND to robotic treatment of lymphocele was 118 days (range 30-240). Robot-assisted treatment was successful in all reports. Conclusions: The drainage of lymphocele with the robot-assisted approach appeared safe, feasible, and with satisfactory outcomes for the definitive treatment of symptomatic/infected lymphocele.

A clinical case of the successful VAC therapy in a patient with surgical wound infection after kidney transplantation

Surgical wound infection is the most common complication after kidney transplantation. It is associated with a prolonged hospital stay, repeated surgical procedures, significant costs, which explains the constant search for optimized treatment for wound infections. We describe a clinical case of a patient with an infected lymphocele of the upper pole of the renal graft at Day 29 after kidney transplantation from a donor after brain death. The infected lymphocele was opened and VAC system was installed without the removal of the graft. With antibiotic therapy and modification of the immunosuppressive therapy, the graft function remained stable and no generalization of the infection occurred. The wound was completely clean at Day 28 of VAC therapy, with subsequent tight closure of the wound. The patient was discharged with a functioning graft.

Treatment Outcomes in Patients With Symptomatic Lymphoceles Following Radical Prostatectomy Depend Upon Size and Presence of Infection

ObjectiveTo guide treatment decisions for symptomatic lymphoceles after radical prostatectomy. We examined our experience to create a treatment algorithm. Materials and MethodsWe evaluated all patients that underwent radical prostatectomy at our institution from 2003 to 2012. Presenting signs, management and treatment outcomes were evaluated. ResultsOf the 8081 patients who underwent radical prostatectomy from 2003 to 2012, we identified 123 (1.5%) patients who developed a symptomatic lymphocele, 70 sterile and 53 infected. Percutaneous aspiration was performed in 26 of 123 (21%) patients, of those, 100% recurred. A drain was placed in 86 of 123 (70%) patients for a median of 13 vs 33 days for the infected and sterile lymphocele groups, respectively (P <.001). The median duration of drainage for sterile lymphoceles was 15 vs 58 days for lymphoceles <10 cm vs ≥10 cm (P <.001). Percutaneous drainage was successful in 93% and 86% of patients with infected and sterile lymphoceles, respectively. Laparoscopic unroofing was performed in 18 sterile lymphocele patients (15%) with a success rate of 94%. ConclusionAspiration of symptomatic lymphoceles should be reserved for diagnostic purposes due to a high risk of recurrence. Infected lymphoceles are optimally treated with drain placement and antibiotics, and have excellent resolution rates. While sterile lymphoceles <10 cm can be successfully managed with drain placement, if drainage and sclerotherapy fail, laparoscopic unroofing should be considered. For patients with sterile lymphoceles ≥10 cm there should be a shared decision-making process to weigh the risk of a protracted course if a drain is utilized vs upfront laparoscopic unroofing.

Lipofilled Mini Dorsi Flap: An Efficient Less Invasive Concept for Immediate Breast Reconstruction.

The traditional extended latissimus dorsi flap technique, in addition to lipofilling, has been one of the main procedures used for breast reconstruction after mastectomy. However, to obtain excellent results, this technique requires a large muscle harvest and further lipofilling sessions. The lipofilled mini dorsi flap technique, performed in a single operation, appealed to us as a way to improve the traditional technique.We present our experience with the lipofilled mini dorsi flap technique in a new scenario. We performed breast reconstruction with a lipofilled mini dorsi flap in female patients with breast cancer who underwent mastectomy and immediate breast reconstruction with a lipofilled mini dorsi flap. The operative technique is detailed in this article. The results were evaluated by the patients and the surgical team. We performed 72 lipofilled mini dorsi flap procedures during breast reconstruction surgery from May 2017 to January 2019. Fifty-nine (81.9%) cases were immediate reconstructions. Complications, such as infection or necrosis of the flap, were not observed in this study. We noticed seroma and 1 case of infected lymphocele, which was drained.Body mass index (BMI) was directly related to postoperative dorsal seroma. The authors reported that greater BMI was associated with a higher seroma volume.Most patients evaluated their reconstruction as satisfactory. The surgical team evaluated most of the results as very satisfactory or satisfactory. There were no cases of unsatisfactory results reported either by the patients or the surgical team. The lipofilled mini dorsi flap technique is an efficient, elegant, and less invasive solution that is more easily and quickly performed and achieves excellent long-term results in the immediate breast reconstruction scenario. For the first time to our knowledge, lipofilling was used to reduce the extent of latissimus dorsi dissection. The postoperative follow-up was better tolerated by patients. This technique may be offered to patients regardless of oncological treatment. In our experience, the lipofilled mini dorsi flap method has become the primary technique for immediate breast reconstruction.

Evaluation of Surgical Site Infection in Mini-invasive Urological Surgery.

Surgical Site Infection (SSI) is the most frequent source of infection in surgical patients and the second most frequent cause of hospital-acquired infection. The primary aim of this prospective study was to compare SSI occurrences between minimally invasive surgery (MIS) and open urological surgery. Secondly, perioperative outcomes were evaluated in two different approaches.A consecutive group of 60 patients undergoing urological surgery were prospectively enrolled in a single high-volume center between May and October 2018. We included procedures that were performed by minimally invasive or traditional techniques. We evaluated and compared the incidence of SSI and perioperative outcomes in terms of intraoperative bleeding, post-operative complications, postoperative pain, patient satisfaction with the analgesic treatment, time to flatus, time of oral intake and mobilization, and length of hospital stay. The two groups were homogeneous with regard to demographic data.Superficial incisional SSIs were diagnosed in 10% of cases (3/30) in the second group and 0% in the first (p<0.05); space/organ SSIs developed in 4 patients, which were diagnosed by ultrasound scan and confirmed by abdominal CT: 1 patient (3.3%) in group 1 showed an infected lymphocele, whereas 1 case of infected lymphocele and 2 cases of pelvic abscess were detected in group 2 (10%, p<0.05). All the perioperative outcomes as well as were overall complication rate favored MIS (p<0.05). The use of minimally invasive techniques in urological surgery reduced the risk of SSI by comparison with a traditional approach. In addition, MIS was associated with better perioperative outcomes and a lower overall complication rate.

Robotic prostatectomy leading to a delayed MRSA infected lymphocele: a case report and review of the literature

Prostate cancer is the second leading cancer-related cause of death in the USA with the majority presenting as localized disease. In the last decade minimally invasive, robotic-assisted laparascopic, radical prostatectomy has become the most favored treatment choice. A complication that has been observed in 27% of patients is the formation of an asymptomatic lymphocele. It is a very rare complication for these to become infected, and when they do 80% have occurred 2-12 months post-procedure. In this case report the patient presented with fever and leukocytosis of unknown origin and was found to have a methicillin-resistant Staphylococcus aureus (MRSA) infected lymphocele over 2 years after a radical prostatectomy. The infected fluid collection was drained percutaneously and the patient was treated with a 4-week course of intravenous ceftaroline with complete resolution of symptoms.

Day case laparoscopic radical prostatectomy.

To evaluate the feasibility of performing laparoscopic radical prostatectomy (LRP) as a day case procedure while maintaining patient satisfaction and safety. Herein we report our experience, selection criteria, and discharge criteria for day case LRP. We performed a prospective study with 32 patients undergoing extraperitoneal LRP. These patients were counselled before the procedure that they would go home the same evening of the procedure. Pain scores and quality of life data were recorded day 1 postoperatively via a telephone consultation. The patients underwent routine blood tests on day 2 and an outpatient review on day 7 and regularly thereafter via an assigned key worker. Socio-demographic data, comorbidities, and outcomes were collected for analysis. All patients were successfully discharged the same day of surgery. Mean patient age was 62 years with a mean body mass index of 25. Mean operative time was 147 minutes, and estimated blood loss was 101 ml. Three patients were treated for post operative urinary tract infections; two patients developed infected lymphoceles which required percutaneous drainage and one patient required re-catheterisation due to a burst catheter balloon. Of these six complications four patients required re-admission. Post-operative pain, nausea and vomiting were low whilst patient satisfaction scores were unanimously high in all patients surveyed. The early experience with extraperitoneal LRP as a same day surgery is promising although patients who are at high risk of lymphocele should be excluded. Preoperative patient counselling and selection is paramount. Patient satisfaction is not adversely affected by the shortened stay. Surgeon experience, a well-motivated patient, meticulous attention to detail through an integrated pathway, a multidisciplinary team and adequate postoperative assessment are essential.

Evaluation of sclerotherapy for the treatment of infected postoperative lymphocele

ObjectiveTo evaluate the efficacy and safety of sclerotherapy as the treatment of infected postoperative lymphocele in gynecologic malignancy patients. Materials and methodsPercutaneous catheter drainage (PCD) with or without sclerotherapy was performed for postoperative lymphocele in 75 patients from 2002 to 2014. Eighty-eight lymphoceles (43 non-infected as group A, 45 infected as group B) in 75 patients (mean age ± SD; 50.3 ± 11.3) were included. Sclerotherapy was performed in 17 (39.5%, group A-S) lymphoceles in group A and 14 (31.1%, group B-S) in group B. Absolute ethanol was the most frequently used sclerosant (28 of total 36 sessions). Mean follow-up period was 37 months (range: 1–154). ResultsSclerotherapy was clinically successful in 13 lymphoceles in both group A-S (76.5%) and group B-S (92.9%) without statistical significance. Compared to the pre-sclerotherapy period, group B-S demonstrated significantly decreased drainage volume after sclerotherapy (662.7 ml vs. 100.6 ml, p = 0.019). Group A-S failed to demonstrate significant decrease in drainage volume after sclerotherapy. Recurrence occurred in 4 patients in group A-S and 1 in group B-S, without statistical significance. No major complication was noted. ConclusionSclerotherapy significantly reduces the drainage volume, and might help shorten catheter placement time in infected lymphoceles.

Microbiological evaluation of infected pelvic lymphocele after robotic prostatectomy: potential predictors for culture positivity and selection of the best empirical antimicrobial therapy.

To examine symptomatology and microbiology of infected lymphocele (LC) post-robotic-assisted radical prostatectomy and pelvic lymph node dissection (PLND) and to assess for potential predictors for LC fluid culture positivity. Secondly, to provide general recommendations about use of select antimicrobial therapy. This was a single-center, IRB-approved, retrospective, case series review conducted between October 2008 and October 2014. Data included symptomatology, microbiology of symptomatic LC in men post-robotic prostatectomy and PLND. Those with infected LC were compared to those men with symptomatic LC in the absence of infection. Symptomatic LC was seen in 7% of men, and among those, infected LC was seen in 42%. Infected LC cultures showed predominance of G+ cocci such as S. aureus, coagulase-negative Staphylococcus species, S. pyogenes, S. fecalis and S. viridans. Monomicrobial infection was seen in 85%. Multivariate logistic regression showed leukocytosis [Odds: 12.3, p=0.03, 95% CI (1.2-125)] was significant predictor for culture positivity, whereas trend toward significance for factors such CT findings of thickened walls around the LC +/- air. LC infection following PLND for prostate cancer is usually monomicrobial and caused by Gram+ cocci. GI tract and skin flora are the main habitat. High index of suspicion of infected LC is undertaken in the presence of leukocytosis, fever and abnormal CT findings. Based upon our local hospital antibiogram, combination of IV ampicillin/sulbactam and vancomycin is suggested as the best initial empiric therapy in treating these patients.

Extraperitoneal Radical Trachelectomy With Pelvic Lymphadenectomy: A Novel Fertility-Preserving Option for Early Stage Cervical Cancer Patients.

Radical trachelectomy combined with pelvic lymphadenectomy has been used to treat early stage cervical cancer patients who wish to preserve their fertility. Although vaginal, abdominal, laparoscopic, and robotic approaches have been used during this procedure, all of these approaches cause peritoneal damage, which could result in periadnexal adhesion. The aim of the present study was to introduce and discuss a novel fertility-preserving option, extraperitoneal radical trachelectomy with pelvic lymphadenectomy. To minimize peritoneal damage, we developed a new surgical approach for radical trachelectomy combined with pelvic lymphadenectomy. All surgical procedures associated with radical trachelectomy and pelvic lymphadenectomy were performed via an extraperitoneal approach. During this procedure, the uterine arteries, inferior hypogastric nerve, and pelvic splanchnic nerve were preserved. Extraperitoneal nerve-sparing radical trachelectomy with pelvic lymphadenectomy was performed in 3 Japanese women with International Federation of Gynecology and Obstetrics stage IA2 and IB1 cervical cancers. In all patients, complete resection of the disease was achieved without causing any intraoperative complications. Although an infected lymphocele developed in a patient that was managed conservatively, no severe postoperative complications were noted. No adjuvant treatments were given, and the patients are currently free of disease. To the best of our knowledge, this is the first report about extraperitoneal radical trachelectomy in patients with early stage cervical cancer. Extraperitoneal radical trachelectomy combined with pelvic lymphadenectomy can be safely performed. Because peritoneal damages, which can cause periadnexal adhesion, could be avoided, we consider that this surgical approach may be an ideal treatment option for women with early stage cervical cancer who wish to preserve their fertility.

Infected Lymphocele Extending to the Leg after Robot-Assisted Radical Prostatectomy and Pelvic Lymph Node Dissection

Lymphocele infection is a rare complication after radical prostatectomy and pelvic lymph node dissection (PLND). Here, we present a case of lymphocele infection that extended to the leg two months after robot-assisted laparoscopic radical prostatectomy and PLND. The patient was a 60-year-old man whose chief complaints were fever, chills, and right thigh pain. Computed tomography showed infected lymphocele with right thigh abscess. After percutaneous drainage and intravenous antibiotics, the infection and right thigh abscess were resolved.

Author Reply

A 1% complication, no matter how severe, may not matter until it happens to you. As a surgeon who performs hundreds of prostatectomies per year and who has performed thousands, I have had to watch some of my patients suffer from the complications of lymphoceles, including severe ones like an infected lymphocele. Even if it only happens to 1% of patients, it is worth the effort to try and prevent these.

Potential Surgical and Oncologic Consequences Related to Skin Tattoos in the Treatment of Cervical Cancer

Study ObjectiveSkin tattoos on the feet, legs, and lower abdominal wall are progressively gaining popularity. Consequently, the number of tattooed women with cervical cancer has significantly increased in the last decade. However, pigments of tattoo ink can be transported to regional lymph nodes and potentially clog lymphatic pathways that might also be used by sentinel labeling substances. Therefore, here we report whether the presence of tattoo ink affected pelvic lymph nodes in women with early cervical cancer and discuss its potential oncologic and surgical consequences. DesignProspective observational study. SettingUniversity Hospital in Hamburg, Germany (Canadian Task Force classification II2). PatientsWomen affected by cervical cancer. InterventionsBetween January 2014 and May 2016, 267 laparoscopic oncologic operations, including at least a pelvic sentinel or complete lymphadenectomy, were performed in the Department of Advanced Surgical and Oncologic Gynecology, Asklepios Hospital, Hamburg, Germany. Among these, 191 patients were affected by cervical cancer. Measurements and Main ResultsData of patients in whom dyed lymph nodes without the use of patent blue as a sentinel marker or different from blue-colored pelvic lymph nodes in the case of sentinel procedure were identified and prospectively collected. ResultsIn 9 patients, skin tattoos localized in the lower extremities caused discoloration of at least 1 pelvic lymph node. This effect was observed in 40% of women (9/23) with tattoos in this area of the body. Mean patient age was 34 years (range, 27–56). All women had cutaneous tattoos on their feet or legs, and in 1 woman an additional tattoo situated on the inferior abdominal wall was observed. The stage of cervical cancer was FIGO IB1 in all cases. One woman was at the 16th week of gestation at the time of cancer diagnosis. On average, 26 pelvic lymph nodes (range, 11–51) were harvested from both pelvic basin sides. None of the removed lymph nodes was tumor involved. Three patients (33%) developed postoperatively infected lymphoceles on the side of the tattooed lymph nodes, and 1 woman had multiple episodes of fever without a clear origin. ConclusionIn women affected by cervical cancer with skin tattoos located in the lower limbs, the pelvic lymph nodes can be partially or totally occupied by the ink. This must be taken into consideration, especially for women scheduled exclusively for sentinel node biopsy. Infectious complications related to nodal dissection, in particular infected lymphoceles, may be more frequent in this population.