Surgical Clip-Related Complications after Radical Prostatectomy

Yi, Jin Wook; Kwak, Cheol; Kim, Hyeon Hoe; Ku, Ja Hyeon

doi:10.4111/kju.2010.51.10.683

Cited by 35 publications

(31 citation statements)

References 20 publications

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“…In 20 % (3/15) of the patients experiencing BNC, a migrated foreign body was noted at the level of the vesicourethral anastomosis [2]. This is consistent with multiple recent case reports describing hem-otomotic stricture [10][11][12][13].…”

Section: Etiology/mechanisms/risk Factorssupporting

confidence: 87%

Management Strategies for Post-Prostatectomy Bladder Neck Contractures

Kovell

Terlecki

2015

Curr Urol Rep

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Patients who develop bladder neck contracture (BNC) after surgical treatment for prostate cancer often present with progressive lower urinary tract symptoms. Multiple risk factors contribute to BNC development including patient-related factors and technical considerations at the time of surgery. Initial management begins with endoscopic therapies, including dilation, transurethral incision (TUIBNC), and injection of adjunctive agents. When BNC remains refractory to these therapies, surgical reconstruction of the vesicourethral anastomosis or urinary diversion can be considered in select cases. This review presents an outline of the management of BNC after radical prostatectomy (RP), highlighting the recent literature related to the subject.

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Section: Etiology/mechanisms/risk Factorssupporting

confidence: 87%

Management Strategies for Post-Prostatectomy Bladder Neck Contractures

Kovell

Terlecki

2015

Curr Urol Rep

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“…Anastomotic urine leak, intravesical foreign body, increased operative time and increased estimated blood loss have been cited by multiple studies as risk factors for VUAS. 6,7,13,19,27,28,[33][34][35][36][37][38][39] Given that most of these factors are caused by or increase the risk of poor anastomotic mucosal apposition, it is intuitive to assume this as an important risk factor for VUAS formation. 29 To address this concern, Srougi et al described a technique in which the bladder neck mucosa was everted to improve apposition and reduce VUAS, but an improvement in rates of VUAS with this technique was not noted.…”

Section: Epidemiologymentioning

confidence: 99%

An update on best practice in the diagnosis and management of post-prostatectomy anastomotic strictures

Rocco

Zuckerman

2017

Therapeutic Advances in Urology

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Postprostatectomy vesicourethral anastomotic stenosis (VUAS) remains a challenging problem for both patient and urologist. Improved surgical techniques and perioperative identification and treatment of risk factors has led to a decline over the last several decades. High-level evidence to guide management is lacking, primarily relying on small retrospective studies and expert opinion. Endourologic therapies, including dilation and transurethral incision or resection with or without adjunct injection of scar modulators is considered first-line management. Recalcitrant VUAS requires surgical reconstruction of the vesicourethral anastomosis, and in poor surgical candidates, a chronic indwelling catheter or urinary diversion may be the only option. This review provides an update in the diagnosis and management of postprostatectomy VUAS.

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“…As consequence, Authors suggest to minimize the use of clips on tissue immediately adjacent to the anastomosis, and to make every effort to retrieve loose clips after the procedure (1-2). Patients most commonly present with urinary retention, obstructive lower urinary tract symptoms, hematuria, pyuria, dysuria, urgency, painful micturition (1). Surgical clips may be a source of pain.…”

Section: Discussionmentioning

confidence: 99%

Nonabsorbable polymer clip as a cause of chronic perineal pain after radical prostatectomy: Description of a case treated by transperineal approach

Creta

Meo

Buonopane

et al. 2017

Arch Ital Urol Androl

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The occurrence of persistent perineal pain caused by surgical clips has rarely been described after radical prostatectomy (RP). We describe the case of a patient complaining of chronic perineal pain occurred soon after robotic RP, refractory to conventional medical therapy and exacerbated by the sitting position. Pain was related to a nonabsorbable polymer clip used to secure lateral pedicles. A transpeerineal approach was used to perform an hydrodissection of the rectovesical space at the level of the surgical clip combined with local injection of mepivacaine and betametasone. The patient experienced a clinically significant reduction of pain that remained stable at three months' follow-up.KEY WORDS: Pain; Prostatic neoplasms; Prostatectomy. the early post-operative course of RP and it worsened in the sitting position. Maximum pain intensity was 8 on a Visual Analogue Scale (VAS) 0 to 10. The patient denied any Lower Urinary Tract Symptom, macroscopic hematuria and fewer. Physical examination of the abdomen and the perineum was unremarkable. Digital rectal examination excluded local prostate cancer recurrence. However, a nonabsorbable polymer clip could be appreciated along the left neurovascular bundle, far from the urethrovesical anastomosis and finger pressure applied on it was able to elicit and intensify the pain described by the patient. Patient post-operative Prostate Specific Antigen was undetectable. Findings from laboratory assessments and abdominal ultrasound were unremarkable. We hypothesized that pain could be secondary to a nerve entrapment syndrome caused by the surgical clip at the level of the left pelvic neurovascular bundle. The patient was hospitalized and we decided to manage it based on evidences from scientific literature in the orthopedic field (3). Accordingly, we used a transperineal approach to perform an hydrodissection of the rectovesical space at the level of the surgical clip combined with local injection of mepivacaine and betametasone. In detail, the procedure was performed under spinal anesthesia with the patient in the lithotomy position. A18 Gauge biopsy needle was used for saline (10 mL) injection in order to obtain hydrodissection of the entrapped neurovascular bundle followed by local injection of 10 mL of mepivacaine 20 mg/mL combined with 2 mL of betametasone 4 mg/2 mL. The procedure was performed under digital and transrectal ultrasound guidance in order to localize the site of injection (Figure 1). The procedure was uneventful and the patient was discharged home on post-operative day 1. On post-operative day 1 pain intensity reported by the patient was 2 on a VAS 0-10 and on post operative day 5 pain intensity was 4. At 3 months follow up pain intensity remained stable (VAS score:4) and the patient declared to be satisfied. Finger pressure on the site of the clip during digital rectal examination was unable to intensify pain intensity.

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Surgical Clip-Related Complications after Radical Prostatectomy

Cited by 35 publications

References 20 publications

Management Strategies for Post-Prostatectomy Bladder Neck Contractures

Management Strategies for Post-Prostatectomy Bladder Neck Contractures

An update on best practice in the diagnosis and management of post-prostatectomy anastomotic strictures

Nonabsorbable polymer clip as a cause of chronic perineal pain after radical prostatectomy: Description of a case treated by transperineal approach

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