Polyserositis and Severe Sepsis after Open Suprapubic Radical Prostatectomy: a Case Report

Abstract

SUMMARY – Infections are well-known complications of radical prostatectomy. In the United States and Europe, the rates of surgical site infections are generally less than 1% and of other infections up to 3%. We report a case of a 62-year-old man who developed severe sepsis with renal insufficiency, paralytic ileus and polyserositis after radical prostatectomy, as a consequence of probable quinolone-resistant bacterial infection. Computed tomography of the abdomen and chest showed polyserositis with bilateral pleural and peritoneal effusions. Treatment with meropenem and other supportive measures resulted in good clinical outcome. This case suggested that severe sepsis with exudative polyserositis was probably caused by mobilization of an infective agent (bacterium) during bladder neck dissection as part of open radical prostatectomy.

Causes of Polyserositis: A Systematic Review

“…Therefore, especially in SLE patients in whom lupus nephritis (and in many cases hypoalbuminemia) is encountered, the necessity to rule out other causes should be reiterated and strengthened. This propensity toward ascribing the term “exudative” to an effusion was also encountered in other cases in which there were either other clear causes for the presence of an effusion and in the absence of any exudate criteria whatsoever, acute renal failure with anuria in a patient with sepsis and generalized edema [ 44 ], or in patients in whom the fluid was analyzed and proven to actually be a transudate [ 45 ]. Therefore, it is clear that there is not only a paucity of data regarding PS, but also that the actual information is, in many cases, of low quality.…”

Effects of laparoscopic radical prostatectomy on wound infection of surgery in patients with prostate cancer: A meta‐analysis

“…Similar to the findings of Fang et al, 40 which suggests a more significant overall clinical efficacy of LRP over ORP. Possible reasons include longer exposure of the surgical wound in ORP, increasing the risk of infection 41 . Additionally, prolonged surgery and increased blood loss, along with extended anaesthesia, may reduce the body's resistance, leading to higher postoperative complication risks 42 .…”

“…Possible reasons include longer exposure of the surgical wound in ORP, increasing the risk of infection. 41 Additionally, prolonged surgery and increased blood loss, along with extended anaesthesia, may reduce the body's resistance, leading to higher postoperative complication risks. 42 LRP provides a clear view of the vascular and nerve structures around the prostate, and its smaller surgical incisions and reduced blood loss, while thoroughly removing the lesion, help protect surrounding tissues, thus reducing the risk of wound infection and other complications.…”

Bilateral pleural effusion: etiology, diagnostics

“…Так, тяжелые формы бактериальной пневмонии нередко осложняются двусторонним экссудативным плевритом [6]. Описаны случаи двустороннего плеврита при пневмонии, вызванной Mycoplasma pneumonia [20,21], бактериальном сепсисе [22], цитомегаловирусной инфекции [23], пневмонии, вызванной COVID-19 (COronaVIrus Disease 2019) [24,25]. ДПВ может осложнять течение грибковых пневмоний, которые обычно развиваются у лиц с иммунодефицитами различной этиологии.…”