[Rectal injuries in radical prostatectomies for cancer. Survey of the ANFUC (Association National de Formation Urologique Continue) 1994].

Abstract

This survey was conducted by 28 urologists members of the ANFUC who reported rectal wounds observed during radical prostatectomy procedures performed for cancer. There were 1,816 procedures reported, 1,785 suprapubic prostatectomies and 28 perineal operations. Kraske access was used in 3 cases. There were 33 wounds to the rectum reported by 17 operators including 31 in suprapubic prostatectomies (1.7% of the operations) and 2 after transperineal operations (7.14%). Preoperative radiotherapy was never used and mechanical preparation was performed in most of the cases with rectal complications (27/33). The wound was sutured in all cases and a colonic derivation was required in 4. Retrospectively this procedure was judged unnecessary in 2 or 3 cases. The post-operative period was uneventful in all cases and the derivations were closed 2 or 3 months later. The conclusions drawn from this survey were the following: the rate of rectal complications in radical prostatectomy is higher in the perineal route. When no preoperative radiotherapy has been performed, simple suture of the rectal wound is sufficient and colonic derivation is not always necessary. It does not appear necessary to interpose an epiploic flap in such cases which would have the disadvantage of requiring opening the peritoneal cavity. These considerations are only applicable to the nonirradiated rectum. Preoperative radiotherapy would undoubtedly have a major effect, but we have had no experience in this series.