Symptomatic Lymphocele Research Articles

PD25-03 ROBOTIC KIDNEY TRANSPLANTATION WITH REGIONAL HYPOTHERMIA VERSUS OPEN KIDNEY TRANSPLANTATION FOR PATIENTS WITH END STAGE RENAL DISEASE: A TWO-ARM STUDY (IDEAL PHASE 2B)

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation & Vascular Surgery I1 Apr 2018PD25-03 ROBOTIC KIDNEY TRANSPLANTATION WITH REGIONAL HYPOTHERMIA VERSUS OPEN KIDNEY TRANSPLANTATION FOR PATIENTS WITH END STAGE RENAL DISEASE: A TWO-ARM STUDY (IDEAL PHASE 2B) Akshay Sood, Rajesh Ahlawat, Wooju Jeong, Jacob Keeley, Firas Abdollah, Mahendra Bhandari, and Mani Menon Akshay SoodAkshay Sood More articles by this author , Rajesh AhlawatRajesh Ahlawat More articles by this author , Wooju JeongWooju Jeong More articles by this author , Jacob KeeleyJacob Keeley More articles by this author , Firas AbdollahFiras Abdollah More articles by this author , Mahendra BhandariMahendra Bhandari More articles by this author , and Mani MenonMani Menon More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1330AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To examine association between minimally invasive renal recipient surgery and meaningful postoperative outcomes including graft function, 6-month complications, and graft and patient survival. METHODS Patients with end stage renal disease undergoing living-donor renal transplantation either via open or robotic kidney transplantation were included in the study; inclusion/exclusion criteria have been previously published. Non-parsimonious propensity score methods were used to reduce baseline differences. Conditional and Cox regression models evaluated the association between robotic surgery and outcomes. Ding-VanderWeele method estimated the impact of unknown confounders on study findings. Primary outcome was delayed graft function (DGF), defined as need for dialysis within 1 week of surgery. Secondary outcomes included postoperative complications, pain, graft rejection, and graft and patient survival. RESULTS Of the 654 patients that met study criteria during the 3-year study period (January 2013 to December 2015), 126 underwent robot-assisted kidney transplantation. Propensity score matching (1:3) yielded an overall sample of 504 patients (robotic, n=126; open, n=378). All patients had a minimum follow-up of 1 year. Within the matched-pair cohort, the robotic approach was associated with lower rates of wound infections (0% vs 4%, chi-square p=0.023) and symptomatic lymphoceles (0% vs 7% [95% CI: 4.4 to 9.6%] at 36 months, log-rank p=0.003), as well as, reduced postoperative pain, requirement for narcotic analgesia and blood loss. There were no differences among the two groups, robotic versus open, with respect to graft function (DGF 0% vs 2.4%, chi-square p=0.081), length of hospital stay (median 8 days for both, Mann-Whitney p=0.647), graft rejection (16.2% [95% CI: 9 to 23.4%] vs 18.6% [95% CI: 12.4 to 24.6%] at 36 months, log-rank p=0.643), and graft (95.2% [95% CI: 86 to 99.3%] vs 96.3% [95% CI: 93.1 to 99.4%] at 36 months, log-rank p=0.266) and overall survival (94.5% [95% CI: 89.3 to 98.9%] vs 98.1% [95% CI: 96.7 to 99.5%] at 36 months, log-rank p=0.307). Ding-VanderWeele analysis suggested a minimal influence of unknown confounders on study findings. CONCLUSIONS Robotic kidney transplantation with regional hypothermia was associated with a lower rate of postoperative complications, and improved patient comfort. There were no differences with respect to graft function, and graft and overall survival. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e546-e547 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Akshay Sood More articles by this author Rajesh Ahlawat More articles by this author Wooju Jeong More articles by this author Jacob Keeley More articles by this author Firas Abdollah More articles by this author Mahendra Bhandari More articles by this author Mani Menon More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Bevacizumab Does Not Reduce the Lymphocele Rate in Advanced Ovarian Cancer After Complete Cytoreductive Surgery.

We aimed to evaluate the impact of bevacizumab on the lymphocele rate in patients after complete cytoreductive surgery for advanced ovarian cancer. This retrospective study included patients with advanced ovarian cancer who had undergone complete cytoreductive surgery with pelvic and para-aortic lymphadenectomy at the Gustave Roussy Institute from 2005 to 2014. The introduction of bevacizumab was discussed in a multidisciplinary meeting. During the study period, 247 patients were included; 24.6% of patients (61 patients) received adjuvant bevacizumab. The rate of symptomatic lymphocele was 34% (84 patients). In the lymphocele group, patients tended to receive adjuvant bevacizumab more often than did the control group (32% and 21%, respectively, p=0.05). In multivariate analysis, bevacizumab was not significantly associated with the risk of symptomatic lymphocele (hazard ratio(HR)=1.62, 95% confidence interval(CI)=0.87-3.01, p=0.12). Adjuvant bevacizumab has no impact on the formation or duration of symptomatic lymphocele in patients after complete cytoreductive surgery for advanced ovarian cancer.

A collagen-fibrin patch for the prevention of symptomatic lymphoceles after pelvic lymphadenectomy in women with gynecologic malignancies: A randomized clinical trial

ObjectiveTo evaluate the efficacy of a collagen-fibrin patch for the prevention of symptomatic lymphoceles after pelvic lymphadenectomy in women with gynecologic malignancies. MethodsIn a multicenter, randomized, clinical trial, 164 women with pelvic lymphadenectomy were allocated either to bilateral pelvic application of two collagen-fibrin patches or no intervention. Main outcome was efficacy, defined as reduction of symptomatic lymphocele rate diagnosed within four weeks after surgery. Secondary outcomes were asymptomatic lymphoceles and subsequent interventions. Sample size was based on the assumption that application of a collagen-fibrin patch reduces the prevalence of symptomatic lymphoceles by at least 66%. The study was single-blinded, i.e., patients and primary outcome assessors, but not surgeons, were blinded to the treatment allocation. ResultsA total of 75 women were randomized to the intervention and 89 to the control group. All women received the allocated intervention. In total, 42 (27.4%) lymphoceles and 8 (5.2%) symptomatic lymphoceles were observed. Symptomatic lymphoceles were observed in 5/68 (7.4%) women in the intervention group and 3/85 (3.5%) women in the control group (p = 0.47). Asymptomatic lymphoceles were observed in 16 (23.5%) women in the intervention group compared to 18 (21.2%) in the control group (p = 0.85). In a multivariate logistic regression model, no independent risk factor for the development of a symptomatic lymphocele was ascertained. DiscussionIntraoperative application of collagen-fibrin patches to the pelvic side walls does not reduce the incidence of symptomatic lymphoceles in women with gynecologic malignancies undergoing pelvic lymphadenectomy.

Multicenter evaluation of guideline adherence for pelvic lymph node dissection in patients undergoing open retropubic vs. laparoscopic or robot assisted radical prostatectomy according to the recent German S3 guideline on prostate cancer.

Pelvic lymph node dissection (PLND) is recommended for patients with prostate cancer (PCa) and significant risk for nodal metastases. This study aimed to assess guideline adherence regarding PLND according to the German S3 guideline as example for a national but highly used guideline on prostate cancer and to compare the rate of complications different approaches for radical prostatectomy (RP). Patients undergoing open (RRP), laparoscopic (LARP) or robot-assisted (RARP) RP in six centers in Germany and Austria were included. The primary endpoint was the total number of removed lymph nodes (LN) between the different surgical approaches according to recent guideline recommendations. Secondary endpoints were the number of patients undergoing a sufficient PLND, defined as a removal of at least 10 LN and associated complication rates. 2634 patients undergoing RP were included (RRP: 66%, RARP/LARP: 34%). PLND was performed in 88% (RRP: 88.5%, RARP/LARP: 86.8%, p=0.208). In intermediateor high risk PCa, PLND was performed in 97.2% (RRP: 97.7%, RARP/LARP: 96.2, p=0.048). Of those, the mean number of LN was 19 (RRP: 19 vs. RARP/LARP: 17, p<0.005) and sufficient PLND was observed in 84.6% of RRP compared to 77.2% of RARP/LARP (p<0.005). Symptomatic lymphoceles requiring surgical treatment occurred more often in RRP than in RARP/LARP (4.0% vs. 1.6%, p=0.001). The general guideline adherence regarding performing PNLD and the LN yield is high, regardless of the surgical approach. As expected, lymph node yield was higher when very experienced surgeons conducted the procedure. This should be considered in patients' counseling.

Evaluation of Persistent Lymphatic Fluid Leakage Using a Strategy of Placing a Drain After Kidney Transplantation: A Statistical Analysis to Assess Its Origin

ObjectivesUsing a strategy of placing a surgical drain after kidney transplantation, the duration of a lymphatic fluid leakage and prevalence of a symptomatic lymphocele were retrospectively analyzed. The risk factors for persistent lymphatic fluid leakage or asymptomatic lymphocele were evaluated using multivariate analysis to estimate the origin of the lymphatic fluid leakage. Materials and methodsPatients with persistent lymphatic fluid leakage and symptomatic lymphocele were defined as those with lymphatic fluid drainage >50 mL for more than 15 days and those who required a percutaneous drainage of the lymphocele, respectively. ResultsPersistent lymphatic fluid leakage and symptomatic lymphocele were observed in 40 (16.4%) and 10 (4.1%) of a total of 244 patients, respectively. The maximum durations of lymphatic fluid drainage from the initial drain tube and the second drainage of the symptomatic lymphocele were 48 and 28 days, respectively. Anastomosis of the graft artery to the external iliac artery was an independent risk factor to predict persistent lymphatic fluid leakage or symptomatic lymphocele after kidney transplantation (odds = 2.597, P = .008). ConclusionThe findings of the study suggest that the lymphatic fluid originates from the recipient's iliac lymph trunk rather than from the graft kidney.

Rate of Symptomatic Lymphocele Formation After Extraperitoneal vs Transperitoneal Robot-Assisted Radical Prostatectomy and Bilateral Pelvic Lymphadenectomy.

With the peritoneum acting as a natural surface for lymphatic reabsorption, transperitoneal robot-assisted radical prostatectomy (tRARP) is thought to be associated with a lower incidence of symptomatic lymphoceles (SLs) compared with its extraperitoneal counterpart (eRARP) when bilateral pelvic lymph node dissection (BPLND) is performed. In this study, we aim to determine if there is a difference in SL formation and characteristics between the two approaches. We retrospectively reviewed the records of patients who underwent eRARP or tRARP and BPLND by a single surgeon at a tertiary care academic center from July 1, 2003, to May 31, 2016. Patients with a history of prior pelvic radiotherapy, concomitant inguinal hernia repair, RARP without BPLND, or nonadenocarcinoma of the prostate were excluded. The resulting eRARP and tRARP groups were propensity matched for age, body mass index (BMI), American Association of Anesthesiologists (ASA) score, D'Amico risk classification, and pathological lymph node (LN) count. A total of 3183 RARPs were performed during this time period. After applying exclusion criteria and propensity score matching, 671 patients remained in each group. No statistically significant differences were noted between the groups with regard to age, BMI, ASA, pre-RARP prostate-specific antigen, D'Amico risk classification, biopsy and pathological Gleason sum score, pathological T stage, or margin status. The tRARP group had a higher clinical T stage (p = 0.0015), length of stay (LOS; p = 0.005), pathological N stage (4.92% vs 1.36%, p = 0.0002), and high total LN count (7.22 ± 5.54 vs 5.78 ± 4.18 LNs, p < 0.0001). The eRARP group had higher operating room times (197.4 ± 48.96 minutes vs 192.2 ± 44.12 minutes, p = 0.04) and estimated blood loss (218.4 ± 152.0 mL vs 179.9 ± 119.4 mL, p < 0.0001). No differences were noted in the frequency of SL formation [eRARP: 19/671 (2.83%) vs tRARP: 10/671 (1.49%), p = 0.09] or any clinical characteristics of the SL. Logistic regression analysis showed no effect of LN count (p = 0.071), pathological N stage (p = 0.111), or both combined (p = 0.085) on SL formation. In this cohort, the rate and clinical characteristics of SL were similar among patients treated with eRARP or tRARP and BPLND. The low event rate of SL in each group and trends favoring higher SL with LN yield and pN1 disease in the tRAPR group may deem the study underpowered to make definitive conclusions.

The Efficacy of Fibrin Sealant Patches in Reducing the Incidence of Lymphatic Morbidity After Radical Lymphadenectomy: A Meta-Analysis.

Although pivotal in the oncological management of most tumors, radical lymphadenectomy is associated with a significant number of lymphatic complications. The aim of this meta-analysis is to evaluate the efficacy of fibrinogen sealant patches in reducing lymphadenectomy-related postoperative complications. The electronic databases PubMed, Medline, and Scopus were searched using the terms "lymphadenectomy" or "lymph node dissection" and "TachoSil," "TachoComb," or "fibrin sealant patch." Series evaluating the efficacy of fibrin-thrombin collagen sealant patches were included in the meta-analysis. Overall, 26 studies were retrieved through the literature search. Ten studies including 720 patients met selection criteria. The use of fibrin-thrombin sealant patches to the sole scope of reducing lymphadenectomy-related complications significantly reduced the incidence of lymphocele, symptomatic lymphocele, the need of percutaneous drainage procedures, the volume of lymph drained, and the duration of the drainage. No effect on wound and/or lymphocele infection was noted. This meta-analysis demonstrates that the use of fibrin-thrombin sealant patches significantly reduces the total volume of lymph drained, the duration of the drainage, the incidence of lymphocele and symptomatic lymphocele, and the need for postoperative percutaneous drainage procedures. Its use does not affect the incidence of wound or lymphocele infections.

P.L.E.A.T.—Preventing Lymphocele Ensuring Absorption Transperitoneally: A Robotic Technique

To reduce the risk of symptomatic lymphocele after robotic pelvic lymph node dissection (PLND), we present a technique, preventing lymphocele ensuring absorption transperitoneally (P.L.E.A.T.), where the peritoneum is "pleated" along its midline, leaving 2 lateral openings and allowing lymphatic fluid to drain away from the pelvis and into the abdomen. We analyzed a single-surgeon series of PLNDs during robotic radical prostatectomy, comparing 195 "standard" PLNDs (in which the peritoneum was "re-approximated" or left completely open) with 176 cases in which P.L.E.A.T. was performed. In the group without P.L.E.A.T., 8 cases of symptomatic (grade ≥3, according to the Clavien-Dindo Classification) lymphoceles (4.1%) were recorded. Only 1 patient in the P.L.E.A.T. group complained of symptoms because of a lymphocele (P = .039). No patient reported complications because of the procedure. The P.L.E.A.T. technique is a fast, easy-to-perform, and safe method of reducing the risk of symptomatic lymphocele after transperitoneal robotic PLND.

Prophylaxis of lymphocele formation after kidney transplantation via peritoneal fenestration: asystematic review.

Lymphocele formation after kidney transplantation is a frequent complication which causes pain, secondary graft loss, rehospitalizations and reoperations. Therefore, prophylaxis of lymphocele formation is of utmost importance. To assess the effectiveness of peritoneal fenestration in renal transplantation to prevent lymphocele development. A systematic literature search was conducted combined with hand-searches on lymphocele prevention following renal transplantation using peritoneal fenestration. A qualitative and quantitative analysis of included trials was conducted. We identified three trials including 414 patients and 437 transplantations which studied peritoneal fenestration. Only one randomized controlled trial was identified. Critical appraisal uncovered a number of methodological flaws, predominantly in the nonrandomized studies. Most importantly endpoint definitions varied among trials, selection bias was high and interventions and follow-up were not standardized. Meta-analysis of the included trials showed a significant reduction of clinically symptomatic lymphoceles (OR: 0.23, 95% CI: 0.09-0.64, P=0.005) and overall postoperative fluid collections (OR: 0.49, 95% CI: 0.28-0.88, P=0.02) without a significant increase in other surgical complications. Although peritoneal fenestration is a promising technique to reduce lymphocele formation, only few studies have investigated this technique so far. Given the low methodological quality of included trials, more studies are necessary to evaluate the effectiveness and the risks and benefits of this technique.

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.

MP74-02 ROLE OF EARLY POVIDONE IODINE INSTILLATION IN POST RENAL TRANSPLANT LYMPHORRHOEA: A PROSPECTIVE RANDOMIZED STUDY

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation & Vascular Surgery III1 Apr 2017MP74-02 ROLE OF EARLY POVIDONE IODINE INSTILLATION IN POST RENAL TRANSPLANT LYMPHORRHOEA: A PROSPECTIVE RANDOMIZED STUDY Sanjoy Sureka, Aneesh Srivastava, Priyank Yadav, Rakesh Kapoor, M S Ansari, and Uday Singh Sanjoy SurekaSanjoy Sureka More articles by this author , Aneesh SrivastavaAneesh Srivastava More articles by this author , Priyank YadavPriyank Yadav More articles by this author , Rakesh KapoorRakesh Kapoor More articles by this author , M S AnsariM S Ansari More articles by this author , and Uday SinghUday Singh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2170AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Lymphatic collections commonly develop after renal transplantation although most of them are asymptomatic and resolve spontaneously. Persistent drain output is one of the earliest signs of lymphatic leak. An encysted collection or lymphocoele if symptomatic, can lead to complications as grave as the graft dysfunction itself. This study aimed at prospectively evaluating the role of early povidone iodine instillation in the management of post renal transplant lymphorrhoea. METHODS A prospective evaluation of live related renal transplant recipients was done from Jan 2002 to Dec 2015. Significant lymphorrhoea was defined as >50 mL lymph from drain beyond POD 5. Such patients were randomized into 2 groups: Group A (received 0.5% povidone iodine instillation) and Group B (no instillation). Povidone iodine instillation was done for upto three weeks. The drain was removed if the output decreased to <50ml/day or at three weeks drainage persisted. Absolute risk reduction and NNT were calculated to estimate effect of povidone iodine instillation for the treatment of lymphorrhoea. Fisher exact test or chi square test for categorical data descriptive statistics and t test was used for continuous data SPSS version 20.0. Armonk, NY: IBM Corp. RESULTS 1766 patients underwent renal transplant during this period. 117 patients with lymphorrhoea through the drain underwent randomization into group A (n=61) and group B (n=56). In group A, 58(95%) patients had successful resolution within two weeks while in group B, 34(60%) patients had successful resolution within two weeks. Symptomatic lymphocoele was present in 1 patient in group A and 7 patients in group B on follow up. Absolute risk reduction was 10.8% and for every symptomatic lymphocoele prevented, 10 patients needed povidone iodine instillation. CONCLUSIONS Povidone iodine instillation helps in early resolution of post renal transplantation lymphorrhoea as well as reduces the incidence of lymphocoele formation. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e995-e996 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Sanjoy Sureka More articles by this author Aneesh Srivastava More articles by this author Priyank Yadav More articles by this author Rakesh Kapoor More articles by this author M S Ansari More articles by this author Uday Singh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Critical appraisal of consecutive 36 cases of post renal transplant lymphocele: a proposed algorithm.

Lymphyocele by definition is the collection of lymph that is contained by a pseudomembrane. Management of lymphocele varies from simple aspiration or aspiration with sclerothreapy to more invasive technique, such as internal/external drainage. We present the results of 36 patients who developed pelvic lymphocele after renal transplant. A total of 1720 patients underwent living related donor renal allograft transplant at our centre. Of the total 1720 transplants 36 patients developed symptomatic lymphocele and underwent definitive management. Retrospectively analysis of the clinical data of these 36 patients was done. Thrirt six patients (2.09%) had a clinically significant lymphocele, which needed definitive management. All these patients underwent ultrasound guided drain placement and sclerosant injection. Fifteen out of 36 patients (41.6%) had successful treament with percutaneous drain placement. Laparoscopic marsupialization of lymphocele was done in 21 patients who failed percutaneous drain insertion therapy after diagnostic aspiration. Laparoscopic Marsupilization was successful in 18 out of 21 patients (85.7%). The 3 patients with failed laparoscopic marsupialization were managed with open surgical marsupialization. Significant number of lymphocele post renal transplant may be asymptomatic but still cause deterioration of renal function even without causing obstructive uropathy. Lymphoceles causing renal deterioration or symptoms should be managed in a step ladder fashion starting from percutaneous drainage to laparoscopic marsupilization to open surgical approach. Asymptomatic recurrences post marsupialization are common and should be only closely observed unless they become symptomatic or cause deterioration of renal function. A systematic protocol may help in treating these patients better.

卵巣癌術後の症候性リンパ嚢胞に対して腹腔鏡下リンパ嚢胞開窓術を施行した1例

卵巣癌術後の症候性リンパ嚢胞に対して腹腔鏡下リンパ嚢胞開窓術を施行した1例

Large Bilateral Symptomatic Pelvic Lymphoceles Following a Radical Prostatectomy

Large Bilateral Symptomatic Pelvic Lymphoceles Following a Radical Prostatectomy

Incidence, Risk Factors and Management of Symptomatic Lymphoceles after Radical Retropubic Prostatectomy

IntroductionWe investigated the incidence, clinical course and risk factors for symptomatic lymphoceles after radical retropubic prostatectomy with pelvic lymph node dissection. Moreover, we explored parameters for the failure of percutaneous lymphocele drainage. MethodsThe incidence of symptomatic lymphoceles in patients with prostate cancer who underwent radical retropubic prostatectomy with pelvic lymph node dissection in our department between 2008 and 2013 was investigated retrospectively. The occurrence of lymphoceles was correlated with several clinical and histopathological parameters. In addition, logistic regression analysis was performed to assess the value of independent variables with regard to the development of symptomatic lymphoceles and failure of percutaneous drainage. ResultsA total of 599 consecutive patients treated with radical retropubic prostatectomy with pelvic lymph node dissection were included in the study, of whom symptomatic lymphocele had developed in 5%. Median time to diagnosis of symptomatic lymphocele was 22.5 days. Median time of percutaneous drainage was 16 days. Overall 43% of patients required surgical unroofing. On multivariate analysis age greater than 67 years (OR 3.27, p=0.005) and removal of more than 10 lymph nodes (OR 2.57, p=0.018) were independent predictors for the development of symptomatic lymphoceles. A significantly increased risk of percutaneous drainage failure was observed in patients who had a body mass index greater than 27 kg/m2 (OR 7.0, p=0.03), followed by a trend for those with a drainage volume of more than 375 ml 24 hours after puncture (OR 3.89, p=0.12). ConclusionsSymptomatic lymphocele will develop in 1 of 20 patients after radical retropubic prostatectomy with pelvic lymph node dissection. The number of lymph nodes removed constitutes an independent risk factor. Percutaneous drainage failure is associated with high body mass index and high drainage volume within the first 24 hours after puncture.

Editorial Comment

The authors are to be congratulated for performing a prospective randomized trial pertaining to the incidence and possible prevention of pelvic lymphoceles following pelvic lymph node dissection (PLND) during robotic-assisted radical prostatectomy (RARP) with an absorbable hemostatic agent (Arista AH). 1 Gilbert D.R. Angell J. Seager C. Abaza R. Evaluation of absorbable hemostatic powder for prevention of lymphoceles following robotic prostatectomy with lymphadenectomy. Urology. 2016; https://doi.org/10.1016/j.urology.2016.06.071 Abstract Full Text Full Text PDF Scopus (15) Google Scholar The authors provide a nice discussion regarding the incidence of pelvic lymphoceles following RARP and PLND. Although symptomatic lymphoceles may be very costly and difficult to deal with, they are not common. In fact, the authors note the absence of symptomatic lymphoceles in this study. We may be chasing a problem that does not need to be addressed. For that reason, I loathe cross-sectional imaging following RARP and PLND. The finding of asymptomatic lymphoceles on imaging provides patients, families, and treating physician's unnecessary anxiety. One conclusion I reach from this study is that we probably should not be looking for trouble with the use of postoperative imaging.

Safety and Efficacy of Extended Duration of Thromboembolic Prophylaxis Following Radical Cystectomy: An Initial Institutional Experience

IntroductionWe evaluated the safety and efficacy of extended duration of pharmacological prophylaxis for preventing symptomatic venous thromboembolism following radical cystectomy. MethodsWe recorded symptomatic venous thromboembolism and lymphocele events within 30 days of radical cystectomy among patients treated with extended duration of pharmacological prophylaxis (enoxaparin 40 mg subcutaneously daily for 30 days). We compared these outcomes to those in the cohort of patients who underwent radical cystectomy at our institution in the year prior to extended prophylaxis implementation. Unadjusted descriptive statistics and univariate analyses were performed using the Pearson test or the Fisher chi-square test for categorical variables and the Wilcoxon rank sum test for continuous variables. ResultsWe analyzed the records of 52 patients who did and 82 who did not receive extended duration of pharmacological prophylaxis after radical cystectomy. Only 1 patient (1.9%) discharged home on extended prophylaxis was diagnosed with venous thromboembolism within 30 days of RC compared to 5 (6.1%) who had not received extended prophylaxis. In 3 patients symptomatic lymphocele developed within 30 days of radical cystectomy, including 1 (1.9%) who had received extended prophylaxis and 2 (2.4%) who had not. No patient in either cohort was rehospitalized for bleeding complications. ConclusionsOur initial experience suggests that extended duration of pharmacological prophylaxis is associated with a lower rate of venous thromboembolism following radical cystectomy and it does not increase the risk of bleeding or symptomatic lymphocele. These data warrant validation in larger patient cohorts, ideally in the prospective clinical trial setting.

Treatment of the Lymphocele After Kidney Transplantation: A Single-center Experience.

Lymphocele is one of the most common complications after kidney transplantation. It is usually asymptomatic, but can cause pressure on the kidney transplant, ureter, bladder, and adjacent vessels with deterioration of graft function, ipsilateral leg edema, and external iliac vein thrombosis. Peritoneal fenestration is a well-established method for treatment. In this report, we present the incidence of symptomatic lymphocele requiring treatment (LRT), demographic and surgical factors that influenced lymphocele formation, its clinical presentation, and 2 types of treatment: open and laparoscopic intraperitoneal drainage in the experience of our center. We retrospectively analyzed all kidney transplantations performed between January 2007 and December 2014 in Gdansk Transplantation Center (n= 740) and selected patients with LRT. LRT occurred in 59 cases (8%). All other patients transplanted during the same time (n= 681) were treated as a control group in the univariate and multivariate analysis of risk factors of the lymphocele formation. Surgical intraperitoneal drainage was performed in an open method in 53 cases and laparoscopically in 6 patients. We observed recurrence of lymphocele in 11 cases (18.6%). Acute rejection episodes (ARE) and delayed graft function (DGF) were more frequent in patients with LRT. ARE and age were independent risk factors for LRT in multivariate analysis. The mean estimated glomerular filtration rate by the Modification of Diet in Renal Disease method at 1 month after the fenestration was higher than before the operation (51.7 and 43.6mL/min, respectively). Fenestration is a safe and effective method of treatment of symptomatic lymphocele. ARE, DGF, and older age were associated with a greater risk of LRT.

Use of TachoSil® to Prevent Symptomatic Lymphocele after an Aggressive Tumor Debulking with Lymphadenectomy for Advanced Stage Ovarian Cancer. A Pilot Study

Objective: To describe the incidence of symptomatic lymphocele (SLC) after an aggressive tumor debulking surgery and lymphadenectomy in patients with ovarian cancer and peritoneal carcinomatosis with or without TachoSil®. Material and Methods: A pilot retrospective comparative observational study was performed between patients with advanced ovarian cancer International Federation of Gynecology and Obstetrics stages III-IV who underwent complete debulking surgery and radical retroperitoneal lymphadenectomy. In 18 patients, 4 TachoSil® patches were placed in the retroperitoneal area, since January 2014-October 2014. This group was compared with other 18 consecutive patients matched by age, International Federation of Gynecology and Obstetrics stage, surgical complexity, American Society of Anesthesiologists score, comorbidity, and BMI without the use of TachoSil®. Results: Baseline characteristics were similar between groups. There were no statistically significant differences in terms of surgical complexity, surgical time, estimated blood loss, node removed, length of hospital stay, and complications between groups. SLC was diagnosed in 7 patients (38.8%) without TachoSil®, and in 2 patients (11.1%) with TachoSil® (p = 0.121). The use of TachoSil® was associated with a statistically significant lower re-admission rate (p = 0.041) and with a significantly shorter time to adjuvant chemotherapy (p = 0.02). Conclusions: Using TachoSil® in women with advanced stage ovarian cancer who underwent radical debulking with retroperitoneal lymph node dissection is associated with a non-statistically significant reduction in the incidence of SLC. A larger-scale randomized controlled study should be conducted to confirm our preliminary results.

MP06-02 SAFETY AND EFFICACY OF EXTENDED-DURATION THROMBOEMBOLIC PROPHYLAXIS FOLLOWING RADICAL CYSTECTOMY

You have accessJournal of UrologyBladder Cancer: Epidemiology & Evaluation II1 Apr 2016MP06-02 SAFETY AND EFFICACY OF EXTENDED-DURATION THROMBOEMBOLIC PROPHYLAXIS FOLLOWING RADICAL CYSTECTOMY Harras Zaid, David Yang, Matthew Tollefson, Igor Frank, William Parker, R. Houston Thompson, R. Jeffrey Karnes, and Stephen Boorjian Harras ZaidHarras Zaid More articles by this author , David YangDavid Yang More articles by this author , Matthew TollefsonMatthew Tollefson More articles by this author , Igor FrankIgor Frank More articles by this author , William ParkerWilliam Parker More articles by this author , R. Houston ThompsonR. Houston Thompson More articles by this author , R. Jeffrey KarnesR. Jeffrey Karnes More articles by this author , and Stephen BoorjianStephen Boorjian More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2163AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Venous thromboembolism (VTE) has been reported in approximately 5-7% of patients undergoing radical cystectomy (RC). While extended-duration pharmacologic prophylaxis (EDPP) has been investigated following surgery for a variety of malignancies, limited data exist regarding usage in bladder cancer. Herein, we evaluated the efficacy and safety of EDPP after RC. METHODS We instituted a change in our clinical practice beginning May 2014 such that patients undergoing RC were prescribed 30 days of enoxaparin at discharge. We recorded symptomatic VTEs and lymphoceles within 30 days of RC among patients treated from 5/14-6/15, and compared these outcomes to patients who underwent RC at our institution in the year prior to EDPP implementation. Patients in both groups received subcutaneous unfractionated heparin at anesthesia induction, which was continued TID during hospitalization, in addition to lower extremity sequential compression devices. Patients with a history of VTE prior to surgery (n=24) were excluded from study. Unadjusted descriptive statistics were performed using the Pearson chi-square test for categorical variables and Wilcoxon rank-sum test for continuous variables. RESULTS In total, 58 patients who received EDPP and 82 patients who had not received EDPP after RC were included for analysis. Baseline clinicopathologic demographics were similar between the cohorts (Table). We found that only 1 patient (1.9%) discharged with EDPP was diagnosed with a VTE within 30 days of RC, compared to 5 (6.1%) who had not received EDPP. Mean time to VTE was 18.0 days after RC (range 9-28 days). Events consisted of DVT alone (n=2), DVT and PE (n=2), and PE alone (n=2). The odds ratio for VTE in the absence of EDPP was 3.31 (95% CI 0.38, 29.2). Overall, 3 patients developed a symptomatic lymphocele within 30 days of RC: 1 (1.9%) who received EDPP and 2 (2.4%) who had not (p = 0.84). No patient in either cohort was rehospitalized for bleeding complications. CONCLUSIONS Our initial experience suggests that EDPP was associated with a lower rate of VTE following RC, and does not increase the risks of bleeding or symptomatic lymphocele. Future evaluation in a larger-scale prospective clinical trial setting is needed to confirm the benefit of EDPP in RC patients. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e66 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Harras Zaid More articles by this author David Yang More articles by this author Matthew Tollefson More articles by this author Igor Frank More articles by this author William Parker More articles by this author R. Houston Thompson More articles by this author R. Jeffrey Karnes More articles by this author Stephen Boorjian More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...