Sánchez-Llopis A, Blanco-Silvestre M, Abad-Carratalá G, Martínez-Meneu P, Monsonís-Usó R, Barrios-Arnau L, Ponce-Blasco P, Garau-Perelló C, Capua-Sacoto CD, Rodrigo-Aliaga M

Language: Spanish
References: 27
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PDF size: 131.55 Kb.

ABSTRACT

Objective: To evaluate the incidence, possible risk factors and management of rectal injury during radical prostatectomy.
Design, methodology or approach: Rectal injury is a rare but potentially serious complication of radical prostatectomy (RP). Current evidence is limited as most studies are based on relatively small series. A total of 147 laparoscopic radical prostatectomies were retrospectively reviewed from January 2017 to April 2021. Four patients with rectal injury were found during the procedure.
Results: Of the total number of patients with rectal injury during the procedure, there was extraprostatic extension in the pre-surgery MRI in 50% of the patients. None had a history of previous RT. Primary closure was performed using two layers of suture in all cases. In one case (25%) an intraoperative colostomy was performed. One of the four patients (25%) developed a rectal fistula with secondary peritonitis for which he had to undergo another operation. The time on absolute diet varied from 0 days to 2 days and the time of antibiotic therapy differed in all patients.
Discussion: Rectal injury occurs in 0.1-1.8% of patients undergoing radical prostatectomy and significantly increases the morbidity of the procedure. Most rectal injuries occur during plane dissection maneuvers between the seminal vesicles, prostate, and rectum. To detect it, it is recommended to perform a digital rectal examination and insufflate air through the rectum intraoperatively. The risk factors for its appearance are previous RT, an advanced tumor and a low experience of the surgeon in the procedure. The interposition of tissue in rectal defects continues to generate controversy. Despite primary closure, there is a risk of rectal fistula, especially in cases of defects larger than 2 cm, previous RT, or tumor infiltration of the rectum.
Conclusions: Rectal injury is a rare but serious complication that can complicate the postoperative period of radical prostatectomy.

REFERENCES

1. European Association of Urology. EAUGuidelines Annual Congress Amsterdam. InAmsterdam: EAU Pocket Guidelines; 2020.

2. Hoznek A, Salomon L, Olsson LE, AntiphonP, Saint F, Cicco A, et al. Laparoscopic RadicalProstatectomy. EUR. 2001;40(1):38–45. doi:https://doi.org/10.1159/000049747

3. Türk I, Deger S, Winkelmann B, Schönberger B,Loening SA. Laparoscopic radical prostatectomy.Technical aspects and experience with 125cases. Eur Urol. 2001;40(1):46–52; discussion53. doi: https://doi.org/10.1159/000049748

4. Rassweiler J, Sentker L, Seemann O,Hatzinger M, Rumpelt HJ. Laparoscopic radicalprostatectomy with the heilbronn technique:an analysis of the first 180 cases. Journal ofUrology. 2001;166(6):2101–8. doi: https://doi.org/10.1016/S0022-5347(05)65514-0

5. Bollens R, Bossche MV, RoumeguereT, Damoun A, Ekane S, Hoffmann P, etal. Extraperitoneal Laparoscopic RadicalProstatectomy. EUR. 2001;40(1):65–9. doi:https://doi.org/10.1159/000049750

6. Gill IS, Zippe CD. Laparoscopic radicalprostatectomy: technique. Urologic Clinics ofNorth America. 2001;28(2):423–36. doi: https://doi.org/10.1016/S0094-0143(05)70150-6

7. Guillonneau B, Vallancien G. Laparoscopicradical prostatectomy: the montsourisexperience. Journal of Urology.2000;163(2):418–22. doi: https://doi.org/10.1016/S0022-5347(05)67890-1

8. Mandel P, Linnemannstöns A, Chun F, SchlommT, Pompe R, Budäus L, et al. Incidence, RiskFactors, Management, and Complications ofRectal Injuries During Radical Prostatectomy.European Urology Focus. 2018;4(4):554–7. doi:https://doi.org/10.1016/j.euf.2017.01.008

9. Rabbani F, Yunis LH, Pinochet R,Nogueira L, Vora KC, Eastham JA, et al.Comprehensive Standardized Report ofComplications of Retropubic and LaparoscopicRadical Prostatectomy. European Urology.2010;57(3):371–86. doi: https://doi.org/10.1016/j.eururo.2009.11.034

10. Hung C-F, Yang C-K, Cheng C-L, Ou Y-C.Bowel complication during robotic-assistedlaparoscopic radical prostatectomy. AnticancerRes. 2011;31(10):3497–501.

11. Borland RN, Walsh PC. The Managementof Rectal Injury During Radical RetropubicProstatectomy. Journal of Urology. 1992;147(3Part 2):905–7. doi: https://doi.org/10.1016/S0022-5347(17)37418-9

12. Coelho RF, Palmer KJ, Rocco B, MonizRR, Chauhan S, Orvieto MA, et al. EarlyComplication Rates in a Single-Surgeon Series of2500 Robotic-Assisted Radical Prostatectomies:Report Applying a Standardized Grading System.European Urology. 2010;57(6):945–52. doi:https://doi.org/10.1016/j.eururo.2010.02.001

13. Kheterpal E, Bhandari A, Siddiqui S, PokalaN, Peabody J, Menon M. Management of RectalInjury During Robotic Radical Prostatectomy.Urology. 2011;77(4):976–9. doi: https://doi.org/10.1016/j.urology.2010.11.045

14. Wedmid A, Mendoza P, Sharma S, Hastings RL,Monahan KP, Walicki M, et al. Rectal InjuryDuring Robot-Assisted Radical Prostatectomy:Incidence and Management. Journal of Urology.2011;186(5):1928–33. doi: https://doi.org/10.1016/j.juro.2011.07.004

15. Lepor H, Nieder AM, Ferrandino MN.Intraoperative and postoperative complicationsof radical retropubic prostatectomy in aconsecutive series of 1,000 cases. J Urol.2001;166(5):1729–33. doi: https://doi.org/10.1016/S0022-5347(05)65662-5

16. McLaren RH, Barrett DM, Zincke H.Rectal injury occurring at radical retropubicprostatectomy for prostate cancer: etiology andtreatment. Urology. 1993;42(4):401–5. doi: https://doi.org/10.1016/0090-4295(93)90366-I

17. Guillonneau B, Gupta R, El FH, CathelineauX, Baumert H, Vallancien G. LaparoscopicManagement Of Rectal Injury DuringLaparoscopic Radical Prostatectomy. Journal ofUrology. 2003;169(5):1694–6. doi: https://doi.org/10.1097/01.ju.0000059860.00022.07

18. Shekarriz B, Upadhyay J, Wood DP.Intraoperative, perioperative, and long-termcomplications of radical prostatectomy. UrologicClinics of North America. 2001;28(3):639–53. doi: https://doi.org/10.1016/S0094-0143(05)70168-3

19. Häggman M, Brändstedt S, Norlen BJ.Rectal Perforation after Retropubic RadicalProstatectomy: Occurrence and Management.EUR. 1996; 29:337–40. doi: https://doi.org/10.1159/000473772

20. Yıldırım M, Göktaş C, Horuz R, Cetinel CA,Cangüven O, Küçük HF, et al. Rectal injuryduring radical prostatectomy. Ulus TravmaAcil Cerrahi Derg. 2012 May;18(3):250–4. doi:https://doi.org/10.5505/tjtes.2012.04379

21. Katz R, Borkowski T, Hoznek A, Salomon L,Taille A de la, Abbou CC. Operative managementof rectal injuries during laparoscopic radicalprostatectomy. Urology. 2003;62(2):310–3. doi: https://doi.org/10.1016/S0090-4295(03)00326-1

22. Castillo OA, Bodden E, Vitagliano G.Management of rectal injury duringlaparoscopic radical prostatectomy. Int brazj urol. 2006;32:428–33. doi: 10.1590/S1677-55382006000400007

23. Roberts WB, Tseng K, Walsh PC, Han M.Critical appraisal of management of rectalinjury during radical prostatectomy. Urology.2010;76(5):1088–91. doi: https://doi.org/10.1016/j.urology.2010.03.054

24. Gotto GT, Yunis LH, Vora K, Eastham JA,Scardino PT, Rabbani F. Impact of PriorProstate Radiation on Complications AfterRadical Prostatectomy. Journal of Urology.2010;184(1):136–42. doi: https://doi.org/10.1016/j.juro.2010.03.031

25. Schmitges J, Trinh Q-D, Sun M, AbdollahF, Bianchi M, Budäus L, et al. AnnualProstatectomy Volume Is Related to RectalLaceration Rate After Radical Prostatectomy.Urology. 2012;79(4):796–803. doi: https://doi.org/10.1016/j.urology.2011.11.061

26. Ellimoottil C, Roghmann F, Blackwell R,Kadlec A, Greco K, Quek ML, et al. OpenVersus Robotic Radical Prostatectomy in ObeseMen. Current Urology. 2015;8(3):156–61. doi:10.1159/000365708

27. Hinman F Jr. Total retropubicprostatectomy. In:Atlas of Urologic Surgery. 2nd ed. Philadelphia:WB Saunders; 1998. p. 431-445.