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

AUTOR(ES)

Treiyer, Adrian, Haben, Bjorn, Stark, Eberhard, Breitling, Peter, Steffens, Joachim

FONTE

International braz j urol

DATA DE PUBLICAÇÃO

2009-04

RESUMO

PURPOSE: To evaluate the treatment of symptomatic pelvic lymphoceles (SPL) after performing radical retropubic prostatectomy (RRP) and pelvic lymphadenectomy (PLA) simultaneously. MATERIAL AND METHODS: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). RESULTS: 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. CONCLUSIONS: 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.

Documentos Relacionados

• Comparison of renal function after robot - assisted laparoscopic radical prostatectomy versus retropubic radical prostatectomy
• Results of preoperative electrical stimulation of pelvic floor muscles in the continence status following radical retropubic prostatectomy
• Safety and effectiveness evaluation of open reanastomosis for obliterative or recalcitrant anastomotic stricture after radical retropubic prostatectomy
• Learning curve for radical retropubic prostatectomy
• Rupture of vesicourethral anastomosis following radical retropubic prostatectomy