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

Abstract

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.

Infected Lymphocele Extending to the Leg after Robot-Assisted Radical Prostatectomy and Pelvic Lymph Node Dissection

“…Treatment of infected lymphocele generally includes percutaneous drainage and/or sclerotherapy, open evacuation, or laparoscopic marsupialization [7].…”

The deep vein thrombosis caused by lymphocele after endoscopic extraperitoneal radical prostatectomy and pelvic lymph node dissection

“…They are reported to occur in 0.1% to 2% of patients, with no significant differences between surgical approaches. [8][9][10][11] Meticulous cautery or clipping of lymphatic channels during open and laparoscopic prostatectomy may be important in preventing lymphoceles. Many cases of lymphocele are asymptomatic.…”

Lymphozele nach radikaler retropubischer Prostatektomie

“…Pelvin lokalisierte Lymphozelen nach RPE können prinzipiell durch einmalige oder wiederholte perkutane Punktion und Aspiration, durch Drainageneinlage [10], Sklerosierung und chirurgisch auf offenem oder laparoskopischem Weg behandelt werden [5,7,14,21,22,23]. Die perkutane Drainage ist in 50-70%, eine peritoneale Marsupialisation in >90% erfolgreich [13].…”

“…Ein Vergleich der laparoskopischen Technik gegenüber dem offen chirurgischen Verfahren zeigte, dass die laparoskopische transperitoneale Marsupialisation ein effektives und minimal-invasives Verfahren ist, das eine schnelle Genesung des Patienten und damit eine verkürzte Hospitalisation ermöglicht [5,7]. So kann das laparoskopische Verfahren als bevorzugte Therapie bei sterilen Lymphozelen angesehen werden [5,7,21,22,23]. eine gezielte antibiotische Therapie mög-lich.…”