Pelvic Lymphocele Research Articles

Modified Laparoscopic Lymphocele Marsupialization for the Treatment of Lymphoceles After Radical Prostatectomy: First Results

The objective of this study was to describe a simple modification of the laparoscopic pelvic lymphocele marsupialization (LL) following radical prostatectomy lymphoceles (RP-LC). Forty-eight patients (57-76 years) with symptomatic RP-LC underwent surgery in our institute. This was through an open approach in 6 (open drainage [OL]) and LL in rest of the patients (12 with 3 [LL3] and 30 with 2 [LL2] trocars). All except 2 patients were refractory to percutaneous tube drainage and/or sclerotherapy. Pelvic ultrasound and/or computed tomography scans revealed LC size (4 × 5-11 × 12 cm) and volumes (100-1100 mL). All surgeries were uneventful with an operative time of 15-60 minutes for LL and 35-90 minutes for OL and it became shorter with increasing experience with LL2 (15-25 minutes). Mean hospitalization time was 2.3 and 8 days after LL (LL2 and LL3) and OL, respectively. LC were at the right side in 10 patients, at the left side in 6, and at both sides in 14. Postoperative ultrasound revealed primary success in all cases. No patient developed recurrence of or had treatment for lymphocele during a mean follow-up time of 19 months. LL2 is a simple, feasible, and safe procedure that could be used as a first-line treatment for large, noninfected symptomatic or refractive RP-LC.

Management of pelvic lymphoceles after radical prostatectomy: A multicentre community based study

IntroductionPelvic lymphoceles (LC) following radical prostatectomy (LC-RP) have an incidence up to 27%. LC-managements constitute 50% of surgical interventions performed in post-RP patients.ObjectivesTo describe a therapeutic algorithm for LC-managements based on a community based representative retrospective study.Patients and methods: Multicentre data from 304 patients with LC-RP were retrospectively examined for LC-managements. RPs were performed by various surgeons from 67 urological departments. All patients had undergone 3 weeks rehabilitation in a specialized hospital where the data base was generated. Indications and results of therapeutic manoeuvres were used to develop a general concept for planning therapy decisions.ResultsMedian age was 64 years. Complications occurred in 9% (28/304) of patients. Median LC-volume was 36 ml (range 20-1800 ml). There were more complications for LCs with ≥100 ml volume than those < 100 ml (27% versus 17%, p = 0.346). Conservative therapy was the standard in uncomplicated cases (87%, 239 of 276 patients), while intervention was done in 13% (puncture and/or drainage, surgery). Surgical intervention was performed significantly more often in complicated cases (82%, 23 from 28 patients; p < 0.001). Based on these data, LCs can be stratified into 3 groups depending on the size and clinical presentation. Therapeutic decisions were used to develop the illustrated new therapy algorithm.ConclusionsThis study based treatment algorithm provides a rationale approach with an accurate LC-classification as regard the indications and decision making for the available LC-RP-therapies. This could facilitate management decisions. Evaluation of this concept prospectively in large patient cohort is mandatory.

1861 PELVIC LYMPHOCELES POST RADICAL PROSTATECTOMY; A SEARCH FOR ANSWERS

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 ...

Extraperitoneal radical cystectomy with extraperitonealization of the ileal neobladder: a comparison to the transperitoneal technique

Transperitoneal radical cystectomy with intraperitoneal ileal neobladder is the standard surgical treatment for muscle-invasive bladder cancer. To reduce morbidity, we established in 2002 an extraperitoneal approach including extraperitonealization of the ileal neobladder. This retrospective study compares the results of the two procedures with a focus on the peri- and postoperative course. Ninety-five male patients with invasive urothelial cancer who underwent radical cystectomy with ileal neobladder at our hospital from January 1998 to May 2007 were analyzed. Forty-seven patients underwent transperitoneal radical cystectomy with intraperitoneal ileal neobladder. The remaining 48 were submitted to the extraperitoneal technique with extraperitonealization of the neobladder. We compared both methods regarding operating time, intraoperative blood loss, complications and oncological outcome. The incidence of postoperative ileus was significantly lower after the extraperitoneal than after the transperitoneal approach (2/48 vs. 10/47 cases; p = 0.012). However, pelvic lymphoceles were more frequent (6 vs. 0 cases; p = 0.014). The two techniques did not differ with regard to the other major and minor complications, the operating time (mean 377.4 vs. 405.4 min) or the intraoperative blood loss (mean 363 vs. 412 ml). Oncological outcome disclosed no difference between both techniques. The extraperitoneal technique with extraperitonealization of the ileal neobladder is comparable in safety and reliability to the transperitoneal surgical approach and yields good peri- and postoperative results with regard to the parameters we examined. Noteworthy are the significant reduction of postoperative ileus and the higher incidence of lymphoceles. Both may be caused by the separate extraperitoneal regional healing processes.

Long-Term Outcomes of the Neobladder in Pediatric Continent Urinary Reconstruction

In rare instances when native bladder tissue is either unsuitable or unavailable a continent neobladder may be an option for pediatric lower urinary tract reconstruction. We report our long-term outcomes and experience in this challenging patient population. A retrospective cohort study was performed of all patients who underwent creation of a neobladder at 2 pediatric institutions. Patient demographics, surgical details and clinical outcomes were abstracted from the medical records. A total of 26 patients were identified with a median age of 8.9 years at surgery. Median followup was 8.0 years. Most procedures used a composite of gastric and ileal tissue. All patients were continent of urine and had a stable upper urinary tract. Median bladder capacity was 400 ml. Postoperative complications included reservoir stones (8 patients), febrile urinary tract infection (8), metabolic acidosis (6), small bowel obstruction (4), bladder perforation (4) and pelvic lymphocele (1). Five patients had difficulty with catheterization due to stomal stenosis. Gross hematuria with clots developed in 1 patient with anuria who had a gastroileal neobladder and was awaiting renal transplantation. No other patient with a gastric component had the hematuria-dysuria syndrome. Five patients had end stage renal disease and subsequently underwent successful renal transplantation. No upper urinary tract deterioration was observed, and no malignant transformation has occurred. Creation of a continent neobladder is a reconstruction option in children when bladder augmentation is not feasible. However, complication rates are not insignificant, underscoring the need for careful long-term followup.

Uni- vs. multiloculated pelvic lymphoceles: differences in the treatment of symptomatic pelvic lymphoceles after open radical retropubic prostatectomy

To evaluate the treatment of symptomatic pelvic lymphoceles (SPL) after performing radical retropubic prostatectomy (RRP) and pelvic lymphadenectomy (PLA) simultaneously. We analyzed, in a retrospective study, 250 patients who underwent RRP with PLA simultaneously. Only patients with SPL were treated using different non- and invasive procedures such as percutaneous aspiration, percutaneous catheter drainage (PCD) with or without sclerotherapy, laparoscopic lymphocelectomy (LL) and open marsupialization (OM). Fifty-two patients (21%) had postoperative subclinical pelvic lymphoceles. Thirty patients (12%) developed SPL. Fifteen patients with noninfected uniloculated lymphocele (NUL) healed spontaneously after performing PCD. The remaining seven patients required sclerotherapy with additional doxycycline. After performing PCD, NUL healed better and faster than noninfected multiloculated lymphocele (NML) (success rate: 80% vs. 16%, respectively). Twenty-seven percent of patients treated initially with PCD, with or without sclerotherapy had persistent lymphocele. All patients were successfully treated with LL. Only one patient had an abscess as a major complication of a persistent SPL after PCD and sclerotherapy and was treated via an open laparotomy. Symptomatic NUL can be treated using PCD with or without sclerotherapy. If this therapy fails as first-line treatment, laparoscopic lymphocelectomy should be considered within a short period of time in order to achieve successful treatment. NML should be treated using a laparoscopic approach in centers where this type of expertise is available. Infected lymphoceles are drained externally. In these cases, percutaneous or open external drainage with adequate antibiotic coverage is preferable.

AUA Best Practice Statement for the Prevention of Deep Vein Thrombosis in Patients Undergoing Urologic Surgery

Summary of VTE prophylaxis recommendations Level of risk Prophylactic treatmentLow Risk ● No prophylaxis other than early ambulationModerate Risk ● Heparin 5000 units every 12 hours subcutaneous starting after surgery ● OR *Enoxaparin 40 mg. (Cr Cl 30 ml/min. 30 mg.) subcutaneous daily ● OR Pneumatic compression device if risk of bleeding is highHigh Risk ● Heparin 5000 units every 8 hours subcutaneous starting after surgery ● OR *Enoxaparin 40 mg. (Cr Cl 30 ml/min. 30 mg.) subcutaneous daily ● OR Pneumatic compression device if risk of bleeding is highVery High Risk ● *Enoxaparin 40 mg. (Cr Cl 30 ml/min. 30 mg.) subcutaneous daily and adjuvant pneumatic compression device, or ● Heparin 5000 units every 8 hours subcutaneous starting after surgery and adjuvant pneumatic compression device* Guidelines and Cautions for Enoxaparin Use ● In patients with a body weight 150 Kg. consider increasing prophylaxis dose of Enoxaparin to 40 mg. subcutaneous every 12 hours. ● Withhold Enoxaparin generally for at least 2 to 3 days after major trauma, and then only consider use after review of current patient condition and risk benefit ratio.

Incidence, risk profile and morphological pattern of venous thromboembolism after prostate cancer surgery.

Venous thromboembolism (VTE) is the most common non-surgical complication after major pelvic surgery. Little is known about the risk factors or the time of development of postoperative venous thrombosis. A cohort of 523 consecutive patients undergoing radical prostatectomy with lymphadenectomy was prospectively assessed by complete compression ultrasound at days -1, +8 and +21. Complete data were available in 415 patients, while four patients had VTE before surgery and were excluded from the analysis. In the remaining 411 patients, 71 VTE events were found in 69 patients (16.8%). Most were limited to calf muscle veins (56.5%), followed by deep calf vein thrombosis (23.2%), proximal deep vein thrombosis (DVT, 14.5%) and pulmonary embolism (PE, 5.8%). Of the 14 patients with proximal DVT/PE, 11 patients (78.6%) developed VTE between days 8 and 21. Risk factors for VTE were a personal history of VTE (OR 3.0), pelvic lymphoceles (LCs) impairing venous flow (OR 2.8) and necessity of more than two units of red blood cells (OR 2.6). Venous thromboembolism is common after radical prostatectomy. A significant proportion develops after day 8, suggesting that prolonged heparin prophylaxis should be considered. Since LCs with venous flow reduction result in higher rates of VTE, hemodynamically relevant lymphoceles should be surgically treated.

Laparoscopic management of early ovarian and fallopian tube cancers: surgical and survival outcome

To evaluate the role of laparoscopy for staging of early ovarian cancers. Case series conducted at the University Hospital with 36 patients who had presumed early-stage adnexal cancers. Laparoscopic staging/restaging was performed. Cases included 20 invasive epithelial tumors, 11 borderline tumors, and 5 nonepithelial tumors. Mean number of peritoneal biopsies, paraaortic nodes, and pelvic nodes were 6, 12.23, and 14.84, respectively. Eighty-three percent of the patients had laparoscopic omentectomy. On final pathology, 7 patients were upstaged. Postoperative complications included 1 small bowel obstruction, 2 pelvic lymphoceles, and 1 lymphocele cyst. Mean duration of follow-up is 55.9 months. Three patients had recurrences. All patients are alive without evidence of the disease. This represents 1 of the largest series and longest follow-ups of laparoscopic staging for early-stage adnexal tumors. Laparoscopic staging of these cancers appears to be feasible and comprehensive without compromising survival when performed by gynecologic oncologists experienced with advanced laparoscopy.

Robotic versus open radical hysterectomy: A comparative study at a single institution

Objective To compare the short-term surgical outcome of patients undergoing robotic radical hysterectomy (RRH) versus open radical hysterectomy (ORH) for the treatment of early stage cervical cancer. Methods IRB approval was obtained for a retrospective chart review of all radical hysterectomies (RHs) for Stage I and II cervical cancer performed at Brigham and Women's Hospital between August 1, 2004 and August 1, 2007. Prior to August 1, 2006 all procedures were ORHs. After this date, all procedures were RRHs. Demographic data, operative data and short-term outcomes were compared. Statistical analysis using t-tests and Fisher's Exact test were performed with SAS software. Results A total of 48 RHs were identified, including 16 RRHs and 32 ORHs. The groups did not differ significantly in age, body mass index, stage, or histology. Mean operative time was significantly longer for RRH than ORH (4:50 vs 3:39 h, p = 0.0002). The mean estimated blood loss was significantly less for RRH than ORH (81.9 vs 665.6 mL, p < 0.0001). The mean number of lymph nodes resected did not differ between RRHs and ORHs (15.6 vs 17.1, p = 0.532). There were no intra-operative complications in the RRH group and one ureteral transection in the ORH group. Three RRH patients (18.8%) suffered post-operative complications which included a vaginal cuff infected hematoma, a transient ureterovaginal fistula, and a pelvic lymphocele, in comparison to seven in the ORH group (21.9%) which included 3 wound infections, two patients with pulmonary emboli, a partial small bowel obstruction with a mesenteric abscess, and a post-operative ileus ( p = 0.999). Mean length of stay was significantly shorter for the RRH group (1.7 vs. 4.9 days, p < 0.0001). Conclusion RRH results in lower blood loss and shorter length of stay, compared to ORH. Intra-operative and post-operative complication rates are comparable. RRH is a promising new surgical technique that deserves further study.

Laparoscopic inguinal hernia repair during laparoscopic radical prostatectomy

To describe our experience of simultaneous laparoscopic radical prostatectomy (LRP) and inguinal hernia repair (LIHR) with a non-absorbable mesh, as there are few reports of simultaneous herniorrhaphy during LRP. Forty patients who had simultaneous LIHR and LRP were retrospectively reviewed. All operations were completed via antegrade techniques using a non-absorbable mesh for the LIHR, as the results with absorbable mesh were disappointing. In all, 48 clinically apparent hernias were repaired in 40 patients (mean age 60 years). Of these, 13 were left-sided, 23 right-sided, and six bilateral; 19 were direct, 14 indirect, two pantaloon, three femoral, and in 10 the type was not recorded. The mean operative duration was 172 min and the mean hospital stay was 1.5 days. Two patients had a urine leak after surgery, which resolved with no further intervention, and two developed a pelvic lymphocele, one at 4 months and the other at 2 months after surgery. Two patients required urinary catheter re-insertion for retention after surgical catheter removal at 9 and 10 days after surgery, respectively. One patient developed a deep venous thrombosis 19 days after surgery. Of the 40 patients, 36 (90%) were followed for a mean of 10 months; none had a hernia recurrence on the repaired side, while two developed a new symptomatic contralateral hernia. LIHR is a successful and reliable way to treat symptomatic patients who are treated surgically for prostate cancer.

Percutaneous Transcatheter Ethanol Sclerotherapy and Catheter Drainage of Postoperative Pelvic Lymphoceles

The aim of this study is to investigate the efficacy and long-term results of percutaneous transcatheter ethanol sclerotherapy (PTES) for postoperative pelvic lymphocele treatment. Fifty-two patients who were referred for lymphocele treatment were included in this study. Sixty lymphoceles of 52 patients were treated by percutaneous treatment with or without ethanol sclerotherapy. Lymphoceles developed in 47 and 5 patients, who underwent gynecologic malignancy operation (31 ovarian cancer, 6 cervix cancer, 10 endometrial cancer) and renal transplantation, respectively. Lymphoceles were catheterized by ultrasonography and fluoroscopy guidance using the Seldinger technique. Lymphoceles smaller than 150 mL underwent single-session ethanol sclerotherapy and the others were treated by multiple-session ethanol sclerotherapy. In 10 patients, percutaneous ethanol sclerotherapy could not be performed and they were treated only by percutaneous catheter drainage. The mean lymphocele volume was 329 mL (15-2900 mL). The mean catheterization duration was 11.8 days (1-60 days). The mean follow up time was 25.8 months (2-64 months). The initial treatment was successful in 46 out of 50 (91%) lymphoceles treated with PTES and 7 out of 10 (70%) lymphoceles treated with percutaneous catheter drainage. Minor complications (secondary infection and catheter dislodgement) were noted in seven (11.6%) patients. Recurrence developed in four and three patients who were treated by PTES and percutaneous catheter drainage, respectively. Five of these patients were treated with PTES without further recurrence. Percutaneous transcatheter ethanol sclerotherapy is an effective and reliable method for the treatment of postoperative lymphoceles.

MP-14.15: Transperineal injection of the tetradecilsolfatum sodium 3% in the treatment of pelvic lymphocele after lymphodenectomia for prostatic cancer

MP-14.15: Transperineal injection of the tetradecilsolfatum sodium 3% in the treatment of pelvic lymphocele after lymphodenectomia for prostatic cancer

Perioperative Complications of Radical Cystectomy in a Contemporary Series

ObjectivesRadical cystectomy is the preferred standard treatment for patients with muscle-invasive bladder cancer. With improvements in intra- and perioperative care lower complication rates have been reported. We retrospectively evaluated our series of patients who underwent radical cystectomy for advanced bladder cancer for perioperative complications as well as operative time, postoperative hospital stay and transfusion rates. Patients and methodsBetween April 1993 and August 2005, 516 radical cystectomies were performed for muscle infiltrating transitional cell carcinoma and other types of neoplastic diseases of the bladder at our institution. The average age was 66.3 yr (31–89). ResultsThe perioperative mortality rate was 0.8%. A total of 141 patients (27.3%) developed at least one perioperative complication. The most frequent medical complications were subileus in 20 (3.9%) patients, deep venous thrombosis in 24 (4.7%), and enterocolitis in 10 (1.9%). Surgical complications included pelvic lymphoceles in 42 (8.1%) patients, wound dehiscence in 46 (8.9%), pelvic hematoma in 4 (0.8%), peritonitis in 4 (0.8%) and small bowel obstruction in 4 (0.8%). The total early reoperation rate was 6.2%. Operative time, postoperative hospital stay and average number of blood units transfused decreased over the period 1993–2005. ConclusionsRadical cystectomy today is a procedure with an acceptable rate of perioperative morbidity and mortality. Improvements in surgical technique and anaesthesia as well as increased quality of perioperative care in recent years have resulted in reduced morbidity and shorter hospital stay.

Post‐transplant lymphocele: An unusual cause of acute urinary retention mimicking urethral injury

Retroperitoneal pelvic lymphoceles are one of the most common complications following renal transplantation, and usually present with a palpable mass, ipsilateral leg edema, hydronephrosis caused by ureteral obstruction, decreased renal function and cutaneous lymphatic fistula. However, lymphocele rarely causes acute urinary retention. In this study, we describe a case of a patient who developed acute urinary retention after renal transplantation mimicking urethral injury. When a transplanted patient demonstrates the inability to void, one should consider bladder outlet obstruction resulting from lymphocele as a possible cause.

Doppler evaluation of external iliac vein hemodynamic changes caused by lymphocele after lymphadenectomy for cervical cancer

To use Doppler sonography to assess the hemodynamic changes in the external iliac vein (EIV) compressed by a pelvic lymphocele after pelvic lymphadenectomy in patients with cervical cancer. Postoperative gray-scale and Doppler sonographic examinations were performed in 71 women after pelvic lymphadenectomy. Twenty healthy women served as controls. When present, the lymphocele was graded on a scale of 1 to 4 based on the percentage of the circumference of iliac vessels in contact with the lymphocele (ie, circumferential contiguity) (grade 1, 0-24%; grade 2, 25-49%; grade 3, 50-74%; grade 4, 75-100%), and in 3 groups according to its maximum diameter (group A, 1-40 mm; group B, 41-60 mm; group C, >60 mm). EIV velocity was measured, and waveform modulation by respiratory movements was analyzed. There were 40 lymphoceles in 22 patients. The mean (+/-SD) EIV velocity was 24.5 +/- 14.8 cm/s in the control group, 38.2 +/- 5.9 cm/s in group 1, 69.2 +/- 29.4 cm/s in group 2, 105.75 +/- 12.36 cm/s in group 3, and 139.5 +/- 33.79 cm/s in group 4. Spontaneous EIV blood flow could not be detected in 2 cases in the later group. EIV flow modulation was significantly lower in patients with greater lymphocele contiguity or diameter. Post-pelvic lymphadenectomy causes EIV extrinsic compression that results in upstream blood stasis, potentially increasing the risk for deep vein thrombosis.

Incidence and Disease Pattern of Venous Thrombembolism after Radical Prostatectomy.

Background: Little is known about the time of development and distribution pattern of venous thrombembolism (VTE) after radical prostatectomy (RPE) for malignancy.Patients and Methods: 415 consecutive patients undergoing standard RPE were prospectively assessed regarding the incidence and distribution pattern of VTE, the hemodynamic relevance of pelvic lymphoceles (LC) and other possible risk factors for VTE. All patients underwent RPE and received heparin prophylaxis until discharge, followed by acetylsalicylic acid 100 mg daily. On day -1, 8 and 21 complete compression ultrasound, measurement of pelvic vein flow and pelvic ultrasound were performed.Results: VTE was found in 17,3% of patients. Most thrombi were limited to calf muscle veins (55,5%). Isolated calf deep vein thrombosis (DVT) was found in 22,2% and proximal DVT in 12,5%. On day 8 and 21 the following incidences of VTE were found: calf muscle vein thrombosis 4.8 and 4.8%; isolated calf vein thrombosis 1.7% and 2.2%; proximal DVT 0.5% and 1.7%; pulmonary embolism 0.5% and 0.5%, respectively. Multivariate analysis revealed surgery time (OR 1.26), number of blood tranfusion (OR 1.73) and venous flow reduction (OR 2.83) as risk factors for the development of VTE. 33.3% of the patients developed a LC postoperatively; of these 5.3% showed a reduction of pelvic vein flow. A venous flow reduction was only seen with LC.Conclusion: The incidence and distribution pattern of VTE after RPE is comparable to major abdominal surgery for malignancy. The development of LC is a significant risk factor for VTE, when pelvic vein flow is impaired. Since the majority of proximal VTE developed between day 8 and day 21 when the patient is already discharged, the concept of a prolonged heparin prophylaxis after RPE should be evaluated prospectively.

Preperitoneal Prosthetic Mesh Hernioplasty for the Simultaneous Repair of Inguinal Hernia during Prostatic Surgery: Experience with 172 Patients

Objectives: We report our experience with posterior preperitoneal prosthetic hernioplasty for inguinal hernia in patients undergoing concomitant pelvic surgery for prostatic pathologies. Methods: 172 patients with unilateral or bilateral inguinal hernia underwent posterior preperitoneal prosthetic hernioplasty during pelvic surgery for BPH and malignant prostatic pathologies. Results: There was no evidence of hernial recurrence after a mean of 30 months and no complications attributable to the hernial repairs, except for 1 patient who developed a small periprosthetic hematoma and 1 patient with a pelvic lymphocele, both spontaneously resolved. Conclusions: Posterior preperitoneal prosthetic hernioplasty for inguinal hernia combined with pelvic surgery for prostatic pathologies should be applied routinely by urologists because it is a relatively simple procedure and with a very low rate of complications and recurrence.

Radiologic imaging and percutaneous treatment of pelvic lymphocele

Pelvic lymphocele, also known as lymphocyst, is a cystic structure caused by lymphatic injury usually secondary to pelvic lymphadenectomy and renal transplantation. Lymphoceles can cause morbidity and rarely mortality by compression of adjacent structures and infectious complications. This review discusses etiology and treatment options for pelvic lymphoceles including surgical and percutaneous methods with emphasis on percutaneous techniques particularly in conjunction with sclerotherapy. Percutaneous catheter drainage with sclerotherapy procedure with various sclerosing agents is described in detail. Ethanol, povidone-iodine, tetracycline, doxycycline, bleomycin, talc and fibrin glue can be used as sclerosing agents. Combination of sclerosing agents to percutaneous catheter drainage significantly improves success rate in the treatment of pelvic lymphoceles. Infected lymphoceles are usually treated solely with percutaneous catheter drainage. Percutaneous treatment can be tailored according to volume of lymphoceles. We generally prefer single session sclerotherapy and 1 day catheter drainage in lymphoceles less than 150 mL, and larger ones are treated by multi-session sclerotherapy until daily drainage decreases below 10 mL. Percutaneous treatment preferably with sclerotherapy should be considered as the first-line treatment modality for pelvic lymphoceles due to its effectiveness, widespread applicability on an outpatient basis, ease of procedure and low complication rate.

Pfannenstiel versus Vertical Laparotomy in Patients Undergoing Radical Retropubic Prostatectomy with Spinal Anesthesia: Results of a Prospective, Randomized Trial

Objective: To evaluate the impact of a standard vertical laparotomy versus a Pfannenstiel transverse laparotomy on intra-, peri-operative, and 6-month follow-up outcome in patients undergoing radical retropubic prostatectomy with pelvic lymphadenectomy with spinal anesthesia. Methods: Between January 2003 and June 2003, 69 age-matched consecutive patients with clinically localized prostate cancer underwent radical retropubic prostatectomy with pelvic lymphadenectomy with spinal anesthesia and were randomized into Group 1 (vertical laparotomy: 35 patients) and Group 2 (Pfannenstiel laparotomy: 34 patients). An extensive analysis of the critical intra-, peri-operative, and 6-month follow-up clinical parameters was performed. Results: Both the hemodynamics and the biochemical balance were not significantly different between the two groups. Overall blood loss ( p = 0.78), autologous ( p = 0.88) and homologous ( p = 0.36) blood transfusions were similar regardless of the type of laparotomy. Surgical time was not significantly ( p = 0.27) different between the two groups. Similarly, the two forms of laparotomy did not differ regarding the length of the surgical incision ( p = 0.21), as measured at the end of the procedure. Post-operative oxygen saturation percentage by pulse oximetry, as well as post-op sedation score, were not significantly different ( p = 0.06 and p = 0.97, respectively). Waiting time in the post-operative holding area ( p = 0.15), and pain score in the post-operative holding area ( p = 0.9) as well as on post-operative day 1 ( p = 0.1) were not significantly different between the two groups. The rate of first flatus passage and of unassisted ambulation were similar regardless of the type of laparotomy during post-operative day day 1. The two types of incision made it possible to remove a similar ( p = 0.34) number of pelvic lymph nodes and were associated to a similar rate of positive surgical margins among pT2 patients. At the 6-month follow-up the occurrence of a pelvic lymphocele and of deep venous thrombosis was similar in the two groups ( p = 0.6 and p = 0.16, respectively). Complete urinary continence and spontaneous erectile function recovery was reported in a similar number of patients regardless of the type of surgical incision ( p = 0.59 and p = 0.40, respectively). Conclusions: These results suggest that a Pfannenstiel transverse suprapubic laparotomy does not result in a significantly different outcome from a standard vertical laparotomy in patients undergoing a radical retropubic prostatectomy with pelvic lymphadenectomy with L2–L3 spinal anesthesia for clinically localized prostate cancer.