title: Risk factors for pelvic lymphoceles post-radical prostatectomy.
abstract: BACKGROUND
  Lymphoceles (LC) represent a well-described rare complication post-radical prostatectomy (RP). Our aim was to determine risk factors and to develop possible prevention strategies for LC in a community-based study.
  
  
  METHODS
  Data from 1163 RP-patients from 67 clinics between January 2002 and December 2004 were retrospectively evaluated. Patients underwent pelvic imaging procedures/LC-management during 3 weeks of rehabilitation post-RP.
  
  
  RESULTS
  LC were identified in 304 patients (26%). Lymphadenectomy was carried out in 92% of patients (1001/1086 patients), from which 28% had LC (n = 277) versus 14% without lymphadenectomy (12/85, P = 0.007). Complications (lower limb edema, pain, thrombosis, infection and bladder compression) were observed in 9% of patients (28/304; 2.4% of total patients); necessitating therapy. LC therapy was carried out in 59 patients (5.9%) with pelvic lymph node dissection (PLND) and in no patients (0%) without PLND (P = 0.021). Risk factors included were patients' age, body mass index, prostate volume, TNM-classification, number of removed lymph nodes, previous surgery/therapy, heparin prophylaxis, surgical instruments and pelvic lymphadenectomy. Univariate analysis showed lymphadenectomy as the only significant risk factor for the development of LC post-RP (P = 0.007). When applying multivariate analyses using stepwise logistic regression, only lymphadenectomy was associated with a significant risk for lymphoceles (odds ratio = 2.6, 95% CI = 1.3-4.9, P = 0.004). Adjusting for other factors, no other factor came close to being significant (P < 0.05). All symptomatic LC were successfully treated without further sequelae.
  
  
  CONCLUSIONS
  Subclinical LC post-RP are more common than thought, and rarely necessitate intervention. Pelvic lymphadenectomy represents the only significant factor contributing to LC-development. Because of this, prevention remains difficult.
authors.affiliation: Department of Urology, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany. wael.khoder@med.uni-muenchen.de
authors.forename: Wael Y
authors.initials: WY
authors.lastname: Khoder
authors.forename: Matthias
authors.initials: M
authors.lastname: Trottmann
authors.forename: Alexander
authors.initials: A
authors.lastname: Buchner
authors.forename: Andrea
authors.initials: A
authors.lastname: Stuber
authors.forename: Sabine
authors.initials: S
authors.lastname: Hoffmann
authors.forename: Christian G
authors.initials: CG
authors.lastname: Stief
authors.forename: Armin J
authors.initials: AJ
authors.lastname: Becker
mesh_terms: D000328:Adult; D000368:Aged; D006801:Humans; D016015:Logistic Models; D008197:Lymph Node Excision / Q000534:rehabilitation / Q000706:statistics & numerical data*; D008210:Lymphocele / Q000453:epidemiology* / Q000534:rehabilitation; D008297:Male; D008875:Middle Aged; D010388:Pelvis; D011183:Postoperative Complications / Q000453:epidemiology* / Q000534:rehabilitation; D011468:Prostatectomy / Q000534:rehabilitation / Q000706:statistics & numerical data*; D011471:Prostatic Neoplasms / Q000453:epidemiology* / Q000534:rehabilitation / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D021701:Sentinel Lymph Node Biopsy