title: Management of pelvic lymphoceles after radical prostatectomy: a multicentre community based study.
abstract: BACKGROUND
  Pelvic lymphoceles (LC) following radical prostatectomy (LC-RP) have an incidence up to 27%. LC-managements constitute 50% of surgical interventions performed in post-RP patients.
  
  
  OBJECTIVE
  To describe a therapeutic algorithm for LC-managements based on a community based representative retrospective study.
  
  
  METHODS
  Multicentre data from 304 patients with LC-RP were retrospectively examined for LC-managements. RPs were performed by various surgeons from 67 urological departments. All patients had undergone 3 weeks rehabilitation in a specialized hospital where the data base was generated. Indications and results of therapeutic manoeuvres were used to develop a general concept for planning therapy decisions. -
  
  
  RESULTS
  Median age was 64 years. Complications occurred in 9% (28/304) of patients. Median LC-volume was 36ml (range 20-1800ml). There were more complications for LCs with ≥ 100ml volume than those <100ml (27% versus 17%, p = 0.346). Conservative therapy was the standard in uncomplicated cases (87%, 239 of 276 patients), while intervention was done in 13% (puncture and/or drainage, surgery). Surgical intervention was performed significantly more often in complicated cases (82%, 23 from 28 patients; p<0.001). Based on these data, LCs can be stratified into 3 groups depending on the size and clinical presentation. Therapeutic decisions were used to develop the illustrated new therapy algorithm.
  
  
  CONCLUSIONS
  This study based treatment algorithm provides a rationale approach with an accurate LC-classification as regard the indications and decision making for the available LC-RP-therapies. This could facilitate management decisions. Evaluation of this concept prospectively in large patient cohort is mandatory.
authors.affiliation: Department of Urology, University Hospital Munich-Grosshadern, Ludwig-Maximilians-University Munich, Germany. khoder.wael@med.uni-muenchen.de
authors.forename: W Y
authors.initials: WY
authors.lastname: Khoder
authors.forename: M
authors.initials: M
authors.lastname: Trottmann
authors.forename: M
authors.initials: M
authors.lastname: Seitz
authors.forename: A
authors.initials: A
authors.lastname: Buchner
authors.forename: A
authors.initials: A
authors.lastname: Stuber
authors.forename: S
authors.initials: S
authors.lastname: Hoffmann
authors.forename: C G
authors.initials: CG
authors.lastname: Stief
authors.forename: A J
authors.initials: AJ
authors.lastname: Becker
mesh_terms: D000368:Aged; D000465:Algorithms; D003658:Decision Making, Computer-Assisted; D006801:Humans; D008210:Lymphocele / Q000209:etiology* / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010388:Pelvis; D011183:Postoperative Complications / Q000209:etiology* / Q000473:pathology / Q000628:therapy*; D011468:Prostatectomy / Q000009:adverse effects*; D012189:Retrospective Studies