Management of rectal injury during laparoscopic radical prostatectomy
PURPOSE: Because laparoscopic radical prostatectomy remains a challenging procedure, rectal injury is always a potential complication. We review the incidence of rectal injuries at our institution in the first 110 consecutive laparoscopic extraperitoneal radical prostatectomies. MATERIALS AND METHOD...
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| Format: | Article |
| Language: | English |
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Sociedade Brasileira de Urologia
2006-08-01
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| Series: | International Brazilian Journal of Urology |
| Subjects: | |
| Online Access: | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1677-55382006000400007 |
| _version_ | 1818683186052333568 |
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| author | Octavio A. Castillo Elias Bodden Gonzalo Vitagliano |
| author_facet | Octavio A. Castillo Elias Bodden Gonzalo Vitagliano |
| author_sort | Octavio A. Castillo |
| collection | DOAJ |
| description | PURPOSE: Because laparoscopic radical prostatectomy remains a challenging procedure, rectal injury is always a potential complication. We review the incidence of rectal injuries at our institution in the first 110 consecutive laparoscopic extraperitoneal radical prostatectomies. MATERIALS AND METHODS: Nine (8%) out of the first 110 laparoscopic extraperitoneal radical prostatectomies performed between December 2001 and February 2004, were complicated by rectal injury. Mean patient age was 64.9 years (range 52 to 74) and mean prostate specific antigen was 11.45 ng/mL (range 4.8 to 37.4). Median preoperative Gleason score was 6 (range 4 to 8) and clinical stage was T1c, T2a, T2b in 6, 2 and 1 patient, respectively. Mean operative time was 228 minutes (range 150 to 300). RESULTS: From 9 injuries, 6 were diagnosed and repaired intraoperatively and 3 were diagnosed postoperatively. From the 6 cases of intraoperative diagnosis and repair, 3 patients healed primarily without colostomy and a recto-urinary fistula was evidenced by pneumaturia in the remaining three. These 3 patients were managed conservatively with urethral catheterization during 30 days. One of the patients required secondary fistula repair by anterior transphincteric, transanal surgical approach (ASTRA). Urinary fistula was diagnosed postoperatively on 3 patients. A diverting colostomy was performed on one patient with secondary fistula repair by ASTRA. Another patient required laparotomy due to peritonitis and urinary fistula was later managed with ASTRA. On the third patient conservative management with urethral catheter was successful. All fistulas repaired with ASTRA evolved uneventfully. There was no perioperative mortality. CONCLUSIONS: Rectal injury during laparoscopic radical prostatectomy can be managed intraoperatively or by a minimally invasive procedure without the need of colostomy. Laparoscopic radical prostatectomy is a challenging procedure and is associated with a very flat learning curve; the incidence of rectal injuries is prone to diminish with experience. |
| first_indexed | 2024-12-17T10:30:44Z |
| format | Article |
| id | doaj.art-e9134b1de8644396a502769d64e187a9 |
| institution | Directory Open Access Journal |
| issn | 1677-5538 1677-6119 |
| language | English |
| last_indexed | 2024-12-17T10:30:44Z |
| publishDate | 2006-08-01 |
| publisher | Sociedade Brasileira de Urologia |
| record_format | Article |
| series | International Brazilian Journal of Urology |
| spelling | doaj.art-e9134b1de8644396a502769d64e187a92022-12-21T21:52:32ZengSociedade Brasileira de UrologiaInternational Brazilian Journal of Urology1677-55381677-61192006-08-0132442843310.1590/S1677-55382006000400007Management of rectal injury during laparoscopic radical prostatectomyOctavio A. CastilloElias BoddenGonzalo VitaglianoPURPOSE: Because laparoscopic radical prostatectomy remains a challenging procedure, rectal injury is always a potential complication. We review the incidence of rectal injuries at our institution in the first 110 consecutive laparoscopic extraperitoneal radical prostatectomies. MATERIALS AND METHODS: Nine (8%) out of the first 110 laparoscopic extraperitoneal radical prostatectomies performed between December 2001 and February 2004, were complicated by rectal injury. Mean patient age was 64.9 years (range 52 to 74) and mean prostate specific antigen was 11.45 ng/mL (range 4.8 to 37.4). Median preoperative Gleason score was 6 (range 4 to 8) and clinical stage was T1c, T2a, T2b in 6, 2 and 1 patient, respectively. Mean operative time was 228 minutes (range 150 to 300). RESULTS: From 9 injuries, 6 were diagnosed and repaired intraoperatively and 3 were diagnosed postoperatively. From the 6 cases of intraoperative diagnosis and repair, 3 patients healed primarily without colostomy and a recto-urinary fistula was evidenced by pneumaturia in the remaining three. These 3 patients were managed conservatively with urethral catheterization during 30 days. One of the patients required secondary fistula repair by anterior transphincteric, transanal surgical approach (ASTRA). Urinary fistula was diagnosed postoperatively on 3 patients. A diverting colostomy was performed on one patient with secondary fistula repair by ASTRA. Another patient required laparotomy due to peritonitis and urinary fistula was later managed with ASTRA. On the third patient conservative management with urethral catheter was successful. All fistulas repaired with ASTRA evolved uneventfully. There was no perioperative mortality. CONCLUSIONS: Rectal injury during laparoscopic radical prostatectomy can be managed intraoperatively or by a minimally invasive procedure without the need of colostomy. Laparoscopic radical prostatectomy is a challenging procedure and is associated with a very flat learning curve; the incidence of rectal injuries is prone to diminish with experience.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1677-55382006000400007prostatic neoplasmsprostatectomylaparoscopyinjuriesrectum |
| spellingShingle | Octavio A. Castillo Elias Bodden Gonzalo Vitagliano Management of rectal injury during laparoscopic radical prostatectomy International Brazilian Journal of Urology prostatic neoplasms prostatectomy laparoscopy injuries rectum |
| title | Management of rectal injury during laparoscopic radical prostatectomy |
| title_full | Management of rectal injury during laparoscopic radical prostatectomy |
| title_fullStr | Management of rectal injury during laparoscopic radical prostatectomy |
| title_full_unstemmed | Management of rectal injury during laparoscopic radical prostatectomy |
| title_short | Management of rectal injury during laparoscopic radical prostatectomy |
| title_sort | management of rectal injury during laparoscopic radical prostatectomy |
| topic | prostatic neoplasms prostatectomy laparoscopy injuries rectum |
| url | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1677-55382006000400007 |
| work_keys_str_mv | AT octavioacastillo managementofrectalinjuryduringlaparoscopicradicalprostatectomy AT eliasbodden managementofrectalinjuryduringlaparoscopicradicalprostatectomy AT gonzalovitagliano managementofrectalinjuryduringlaparoscopicradicalprostatectomy |