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Die radikale Prostatektomie

Intra- und postoperative Komplikationen erkennen und behandeln

Radical prostatectomy

Detection and management of intra- and postoperative complications

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Zusammenfassung

Die chirurgische Entfernung der Prostata mittels radikaler Prostatektomie ist für das organbegrenzte Prostatakarzinom das häufigste Therapieverfahren. Der Eingriff gewährleistet bei komplikationslosem Verlauf eine komplette Entfernung des Tumorgewebes und somit vollständige Heilung des Patienten. Die Operationsmethoden wurden in den letzten Jahrzehnten stetig modernisiert und die Invasivität durch neue Technologien reduziert. Des Weiteren konnte ein optimiertes perioperatives Management die Hospitalisationszeit verkürzen. In diesem Zusammenhang ist das frühzeitige Erkennen intraoperativer und postoperativer Komplikationen von großer Relevanz, um die regelhafte Genesung des Patienten nicht zu gefährden. In diesem Artikel werden die verschiedenen Komplikationsmöglichkeiten während und nach der Operation beschrieben und mögliche Lösungsansätze aufgezeigt.

Abstract

Radical prostatectomy is the most common treatment for organ-confined prostate cancer. Performed without complications and limitations, surgery will allow complete removal of the tumor and, therefore, cure the patient. Operative techniques have been improved during the last few decades to reduce invasiveness of the procedure. Furthermore, optimized perioperative management has shortened hospital stay. To ensure rapid recovery of each patient, early detection of complications is highly relevant. Herein, different scenarios for peri- and postoperative complications are described, and recommendations for best practice solutions are reviewed.

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Literatur

  1. Andonian S, Okeke Z, Okeke DA et al (2008) Device failures associated with patient injuries during robot-assisted laparoscopic surgeries: a comprehensive review of FDA MAUDE database. Can J Urol 15:3912–3916

    PubMed  Google Scholar 

  2. Anheuser P, Treiyer A, Stark E et al (2010) Lymphoceles after radical retropubic prostatectomy. A treatment algorithm. Urologe A 49:832–836

    Article  CAS  PubMed  Google Scholar 

  3. Augustin H, Hammerer P, Graefen M et al (2003) Intraoperative and perioperative morbidity of contemporary radical retropubic prostatectomy in a consecutive series of 1243 patients: results of a single center between 1999 and 2002. Eur Urol 43:113–118

    Article  PubMed  Google Scholar 

  4. Badani KK, Kaul S, Menon M (2007) Evolution of robotic radical prostatectomy: assessment after 2766 procedures. Cancer 110:1951–1958

    Article  PubMed  Google Scholar 

  5. Bill-Axelson A, Holmberg L, Filen F et al (2008) Radical prostatectomy versus watchful waiting in localized prostate cancer: the Scandinavian prostate cancer group-4 randomized trial. J Natl Cancer Inst 100:1144–1154

    Article  PubMed Central  PubMed  Google Scholar 

  6. Catalona WJ, Carvalhal GF, Mager DE et al (1999) Potency, continence and complication rates in 1,870 consecutive radical retropubic prostatectomies. J Urol 162:433–438

    Article  CAS  PubMed  Google Scholar 

  7. Challacombe B, Dasgupta P (2007) Reconstruction of the lower urinary tract by laparoscopic and robotic surgery. Curr Opin Urol 17:390–395

    Article  PubMed  Google Scholar 

  8. Dillioglugil O, Leibman BD, Leibman NS et al (1997) Risk factors for complications and morbidity after radical retropubic prostatectomy. J Urol 157:1760–1767

    Article  CAS  PubMed  Google Scholar 

  9. Ficarra V, Novara G, Artibani W et al (2009) Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a systematic review and cumulative analysis of comparative studies. Eur Urol 55:1037–1063

    Article  PubMed  Google Scholar 

  10. Gillitzer R, Melchior SW, Hampel C et al (2004) Specific complications of radical perineal prostatectomy: a single institution study of more than 600 cases. J Urol 172:124–128

    Article  PubMed  Google Scholar 

  11. Groenman FA, Peters LW, Rademaker BM et al (2008) Embolism of air and gas in hysteroscopic procedures: pathophysiology and implication for daily practice. J Min Invas Gynecol 15:241–247

    Article  Google Scholar 

  12. Guillonneau B, Gupta R, El Fettouh H et al (2003) Laparoscopic [correction of laproscopic] management of rectal injury during laparoscopic [correction of laproscopic] radical prostatectomy. J Urol 169:1694–1696

    Article  CAS  PubMed  Google Scholar 

  13. Guillonneau B, Rozet F, Cathelineau X et al (2002) Perioperative complications of laparoscopic radical prostatectomy: the Montsouris 3-year experience. J Urol 167:51–56

    Article  PubMed  Google Scholar 

  14. Harlan LC, Potosky A, Gilliland FD et al (2001) Factors associated with initial therapy for clinically localized prostate cancer: prostate cancer outcomes study. J Natl Cancer Inst 93:1864–1871

    Article  CAS  PubMed  Google Scholar 

  15. Hu JC, Gold KF, Pashos CL et al (2003) Role of surgeon volume in radical prostatectomy outcomes. J Clin Oncol 21:401–405

    Article  PubMed  Google Scholar 

  16. Hu JC, Nelson RA, Wilson TG et al (2006) Perioperative complications of laparoscopic and robotic assisted laparoscopic radical prostatectomy. J Urol 175:541–546

    Article  PubMed  Google Scholar 

  17. Hu JC, Wang Q, Pashos CL et al (2008) Utilization and outcomes of minimally invasive radical prostatectomy. J Clin Oncol 26:2278–2284

    Article  PubMed  Google Scholar 

  18. Jhaveri JK, Penna FJ, Diaz-Insua M et al (2014) Ureteral injuries sustained during robot-assisted radical prostatectomy. J Endurol 28:318–324

    Article  Google Scholar 

  19. Khemees TA, Novak R, Abaza R (2013) Risk and prevention of acute urinary retention after robotic prostatectomy. J Urol 189:1432–1436

    Article  PubMed  Google Scholar 

  20. Khoder WY, Trottmann M, Buchner A et al (2011) Risk factors for pelvic lymphoceles post-radical prostatectomy. Int J Urol 18:638–643

    PubMed  Google Scholar 

  21. Lance RS, Freidrichs PA, Kane C et al (2001) A comparison of radical retropubic with perineal prostatectomy for localized prostate cancer within the Uniformed Services Urology Research Group. BJU Int 87:61–65

    Article  CAS  PubMed  Google Scholar 

  22. Lavery HJ, Thaly R, Albala D et al (2008) Robotic equipment malfunction during robotic prostatectomy: a multi-institutional study. J Endurol 22:2165–2168

    Article  Google Scholar 

  23. Lee DK, Montgomery DP, Porter JR (2013) Concurrent transperitoneal repair for incidentally detected inguinal hernias during robotically assisted radical prostatectomy. Urology 82:1320–1322

    Article  PubMed  Google Scholar 

  24. Lepor H, Kaci L (2003) Contemporary evaluation of operative parameters and complications related to open radical retropubic prostatectomy. Urology 62:702–706

    Article  PubMed  Google Scholar 

  25. Lepor H, Nieder AM, Ferrandino MN (2001) Intraoperative and postoperative complications of radical retropubic prostatectomy in a consecutive series of 1,000 cases. J Urol 166:1729–1733

    Article  CAS  PubMed  Google Scholar 

  26. Liatsikos E, Rabenalt R, Burchardt M et al (2008) Prevention and management of perioperative complications in laparoscopic and endoscopic radical prostatectomy. World J Urol 26:571–580

    Article  PubMed  Google Scholar 

  27. Loppenberg B, Noldus J, Palisaar J (2011) Complications of radical retropubic prostatectomies based on the Martin criteria. Urologe A 50:1403–1411

    Article  CAS  PubMed  Google Scholar 

  28. Menon M, Tewari A, Baize B et al (2002) Prospective comparison of radical retropubic prostatectomy and robot-assisted anatomic prostatectomy: the Vattikuti Urology Institute experience. Urology 60:864–868

    Article  PubMed  Google Scholar 

  29. Mitropoulos D, Artibani W, Graefen M et al (2012) Reporting and grading of complications after urologic surgical procedures: an ad hoc EAU guidelines panel assessment and recommendations. Eur Urol 61:341–349

    Article  PubMed  Google Scholar 

  30. Montorsi F, Wilson TG, Rosen RC et al (2012) Best practices in robot-assisted radical prostatectomy: recommendations of the Pasadena Consensus Panel. Eur Urol 62:368–381

    Article  PubMed  Google Scholar 

  31. Mottrie A, Ficarra V (2010) Can robot-assisted radical prostatectomy still be considered a new technology pushed by marketers? The IDEAL evaluation. Eur Urol 58:525–527

    Article  PubMed  Google Scholar 

  32. Murphy DG, Bjartell A, Ficarra V et al (2010) Downsides of robot-assisted laparoscopic radical prostatectomy: limitations and complications. Eur Urol 57:735–746

    Article  PubMed  Google Scholar 

  33. Nam RK, Cheung P, Herschorn S et al (2014) Incidence of complications other than urinary incontinence or erectile dysfunction after radical prostatectomy or radiotherapy for prostate cancer: a population-based cohort study. Lancet Oncol 15:223–231

    Article  PubMed  Google Scholar 

  34. Patel VR, Sivaraman A, Coelho RF et al (2011) Pentafecta: a new concept for reporting outcomes of robot-assisted laparoscopic radical prostatectomy. Eur Urol 59:702–707

    Article  PubMed  Google Scholar 

  35. Rabbani F, Yunis LH, Pinochet R et al (2010) Comprehensive standardized report of complications of retropubic and laparoscopic radical prostatectomy. Eur Urol 57:371–386

    Article  PubMed  Google Scholar 

  36. Rassweiler J, Hruza M, Teber D et al (2006) Laparoscopic and robotic assisted radical prostatectomy – critical analysis of the results. Eur Urol 49:612–624

    Article  PubMed  Google Scholar 

  37. Swindle P, Eastham JA, Ohori M et al (2005) Do margins matter? The prognostic significance of positive surgical margins in radical prostatectomy specimens. J Urol 174:903–907

    Article  PubMed  Google Scholar 

  38. Teber D, Gozen AS, Cresswell J et al (2009) Prevention and management of ureteral injuries occurring during laparoscopic radical prostatectomy: the Heilbronn experience and a review of the literature. World J Urol 27:613–618

    Article  PubMed  Google Scholar 

  39. Tewari A, Sooriakumaran P, Bloch DA et al (2012) Positive surgical margin and perioperative complication rates of primary surgical treatments for prostate cancer: a systematic review and meta-analysis comparing retropubic, laparoscopic, and robotic prostatectomy. Eur Urol 62:1–15

    Article  PubMed  Google Scholar 

  40. Touijer K, Eastham JA, Secin FP et al (2008) Comprehensive prospective comparative analysis of outcomes between open and laparoscopic radical prostatectomy conducted in 2003 to 2005. J Urol 179:1811–1817

    Article  PubMed Central  PubMed  Google Scholar 

  41. Trinh QD, Sammon J, Sun M et al (2012) Perioperative outcomes of robot-assisted radical prostatectomy compared with open radical prostatectomy: results from the nationwide inpatient sample. Eur Urol 61:679–685

    Article  PubMed  Google Scholar 

  42. Tyritzis SI, Katafigiotis I, Constantinides CA (2012) All you need to know about urethrovesical anastomotic urinary leakage following radical prostatectomy. J Urol 188:369–376

    Article  PubMed  Google Scholar 

  43. Van Hemelrijck M, Garmo H, Holmberg L et al (2013) Thromboembolic events following surgery for prostate cancer. Eur Urol 63:354–363

    Article  Google Scholar 

  44. Wedmid A, Mendoza P, Sharma S et al (2011) Rectal injury during robot-assisted radical prostatectomy: incidence and management. J Urol 186:1928–1933

    Article  PubMed  Google Scholar 

  45. Weldon VE, Tavel FR, Neuwirth H (1997) Continence, potency and morbidity after radical perineal prostatectomy. J Urol 158:1470–1475

    Article  CAS  PubMed  Google Scholar 

  46. Wen T, Deibert CM, Siringo F et al (2014) Positioning-related complications of minimally-invasive radical prostatectomies. J Endourol 28(4):481–486

    Article  Google Scholar 

  47. Zhu S, Zhang H, Xie L et al (2013) Risk factors and prevention of inguinal hernia after radical prostatectomy: a systematic review and meta-analysis. J Urol 189:884–890

    Article  PubMed  Google Scholar 

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Einhaltung ethischer Richtlinien

Interessenkonflikt. M. Saar, C.H. Ohlmann, M. Janssen, M. Stöckle und S. Siemer geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klink für Urologie und Kinderurologie, Universitätsklinikum des Saarlandes, Kirrberger Straße 1, Geb. 6, 66421, Homburg/Saar, Deutschland

    M. Saar, C.H. Ohlmann, M. Janssen, M. Stöckle & S. Siemer

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  1. M. Saar
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  2. C.H. Ohlmann
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  3. M. Janssen
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  4. M. Stöckle
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Correspondence to M. Saar.

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Saar, M., Ohlmann, C., Janssen, M. et al. Die radikale Prostatektomie. Urologe 53, 976–983 (2014). https://doi.org/10.1007/s00120-014-3500-x

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