Bilateral hydronephrosis subsequent to a giant lymphocele after robotic radical prostatectomy

Abstract

Lymphocele, one the most common complications after pelvic lymph node dissection, is usually observed between postoperative 2nd-12th months as a subclinical complication. We aimed to present a bilateral hydronephrosis case resulting from a giant lymphocele which developed during the early postoperative period after robot assisted radical prostatectomy (RARP) and pelvic lymph node dissection. Cystography was performed on the 7th postoperative day following RARP and extended lymph node dissection. Due to the left sided deviation of the bladder in cystographic images, non-contrast computed tomography (CT) was obtained, which revealed bilateral hydronephrosis and a giant lymphocele in the right pelvic region. The clinical status improved dramatically after percutaneous catheter drainage of the lymphocele. To the best of our knowledge, this is the first bilateral hydronephrosis case in the literature, which developed due to a giant lymphocele that occurred during the early postoperative period after transperitoneal surgery and had an asymptomatic clinical course despite increased creatinine levels. The findings improved dramatically by percutaneous catheter drainage.

Keywords

• Hydronephrosis,Lymphocele,Prostate carcinoma,Robotic surgery

Robotik radikal prostatektomi sonrası dev lenfosele bağlı gelişen bilateral hidronefroz

Abstract

Lenfosel, pelvik lenf nodu diseksiyonu sonrası meydana gelen en sık komplikasyondur ve genellikle postoperatif 2.-12. aylarda görülmekle birlikte subklinik seyreder. Biz bu olgu sunumunda, robot yardımlı radikal prostatektomi (RYRP) ve genişletilmiş pelvik lenf nodu diseksiyonu sonrası oluşan dev lenfosele bağlı olarak gelişen bilateral hidronefroz vakasını sunmayı amaçladık. Robotik radikal prostatektomi ve genişletilmiş pelvik lenf nodu diseksiyonu sonrası postoperatif 7. günde çekilen sistografide mesanenin sol tarafa deviye izlenmesi nedeniyle kontrastsız bilgisayarlı tomografi (BT) çekildi. BT’de sağ pelvik bölgede bilateral hidronefroz ve dev lenfosel izlendi. Lenfoselin perkütan kateter drenajı sonrasında hastanın klinik durumu dramatik şekilde düzeldi. Bu olgu, dev lenfosele bağlı olarak ortaya çıkan bilateral hidronefrozun görülmesi, artmış kreatinin seviyesine rağmen asemptomatik seyretmesi ve transperitoneal cerrahi sonrası erken dönemde gelişmesi açısından literatürdeki ilk vaka olması nedeniyle önem taşımaktadır. Bununla birlikte, lenfoselin perkütan kateter drenajıyla bulgular dramatik bir şekilde düzelebilmektedir.

Keywords

• Hidronefroz,Lenfosel,Prostat kanseri,Robotik cerrahi

References

1. 1. Kölükçü E, Beyhan M, Atılgan D. Factors affecting complications of transrectal ultrasound-guided prostate biopsy: A cohort study with 403 patients in a single center. J Surg Med. 2018;3(2):183-6.
2. 2. Williams SK, Rabbani F. Complications of lymphadenectomy in urologic surgery. Urol Clin North Am. 2011;38(4):507-18.
3. 3. Carbone JM, Nadler RB, Bullock AD, Basler JW. Delayed infection of a pelvic lymphocele following pelvic lymphadenectomy. Urology. 1996;47(1):140-2.
4. 4. Ploussard G, Briganti A, de la Taille A, Haese A, Heidenreich A, Menon M, et al. Pelvic lymph node dissection during robot-assisted radical prostatectomy: efficacy, limitations, and complications-a systematic review of the literature. Eur Urol. 2014;65(1):7-16.
5. 5. Orvieto MA, Coelho RF, Chauhan S, Palmer KJ, Rocco B, Patel VR. Incidence of lymphoceles after robot-assisted pelvic lymph node dissection. BJU Int. 2011;108(7):1185-90.
6. 6. Keskin MS, Argun ÖB, Öbek C, Tufek I, Tuna MB, Mourmouris P, et al. The incidence and sequela of lymphocele formation after robot-assisted extended pelvic lymph node dissection. BJU Int. 2016;118(1):127-31.
7. 7. Lee JY, Diaz RR, Cho KS, Yu HS, Chung JS, Ham WS, et al. Lymphocele after extraperitoneal robot-assisted radical prostatectomy: a propensity score-matching study. Int J Urol. 2013;20(12):1169-76.
8. 8. Davis JW, Shah JB, Achim M. Robot-assisted extended pelvic lymph node dissection at the time of radical prostatectomy: a video-based illustration of technique, results, and unmet patient selection needs. BJU Int. 2011;108(6 Pt 2):993-8.

9. 9. Briganti A, Chun FK, Salonia A, Suardi N, Gallina A, Da Pozza LF, et al. Complications and other surgical outcomes associated with extended pelvic lymphadenectomy in men with localized prostate cancer. Eur Urol. 2006;50(5):1006-13.
10. 10. Naselli A, Andreatta R, Introini C, Fontana V, Puppo P. Predictors of symptomatic lymphocele after lymph node excision and radical prostatectomy. Urology. 2010;75(3):630-5.
11. 11. Karcaaltincaba M, Akhan O. Radiologic imaging and percutaneous treatment of pelvic lymphocele. Eur J Radiol. 2005;55(3):340-54.
12. 12. WY Khoder, C Gratzke, N Haseke, Herlemann A, Stief CG, Becker AJ. Laparoscopic marsupialisation of pelvic lymphoceles in different anatomic locations following radical prostatectomy. Eur Urol. 2012;62(4):640-8.
13. 13. Kim HY, Kim JW, Kim SH, Kim YT, Kim JH. An analysis of the risk factors and management of lymphocele after pelvic lymphadenectomy in patients with gynecologic malignancies. Cancer Res Treat. 2004;36(6):377-83.
14. 14. Zikan M, Fischerova D, Pinkavova I, Slama J, Weinberger V, Dusek L, et al. A prospective study examining the incidence of asymptomatic and symptomatic lymphoceles following lymphadenectomy in patients with gynecological cancer. Gynecol Oncol. 2015;137(2):291-8.