Uni- vs. multiloculated pelvic lymphoceles: differences in the treatment of symptomatic pelvic lymphoceles after open radical retropubic prostatectomy.
OBJECTIVE
To evaluate the treatment of symptomatic pelvic lymphoceles (SPL) after performing radical retropubic prostatectomy (RRP) and pelvic lymphadenectomy (PLA) simultaneously.


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.
Treiyer
Adrian
A
Department of Urology and Pediatric Urology, St Antonius Hospital, Eschweiler, Germany. aetreiyer@yahoo.com.ar
Haben
Bjorn
B
Stark
Eberhard
E
Breitling
Peter
P
Steffens
Joachim
J
D004322:Drainage / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008197:Lymph Node Excision / Q000009:adverse effects*; D008210:Lymphocele / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D008297:Male; D010388:Pelvis; D011184:Postoperative Period; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods; D011471:Prostatic Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D015911:Sclerotherapy