Abstract
Objective
To guide treatment decisions for symptomatic lymphoceles after radical prostatectomy.
We examined our experience to create a treatment algorithm.
Materials and Methods
We evaluated all patients that underwent radical prostatectomy at our institution
from 2003 to 2012. Presenting signs, management and treatment outcomes were evaluated.
Results
Of the 8081 patients who underwent radical prostatectomy from 2003 to 2012, we identified
123 (1.5%) patients who developed a symptomatic lymphocele, 70 sterile and 53 infected.
Percutaneous aspiration was performed in 26 of 123 (21%) patients, of those, 100%
recurred. A drain was placed in 86 of 123 (70%) patients for a median of 13 vs 33
days for the infected and sterile lymphocele groups, respectively (P <.001). The median duration of drainage for sterile lymphoceles was 15 vs 58 days
for lymphoceles <10 cm vs ≥10 cm (P <.001). Percutaneous drainage was successful in 93% and 86% of patients with infected
and sterile lymphoceles, respectively. Laparoscopic unroofing was performed in 18
sterile lymphocele patients (15%) with a success rate of 94%.
Conclusion
Aspiration of symptomatic lymphoceles should be reserved for diagnostic purposes due
to a high risk of recurrence. Infected lymphoceles are optimally treated with drain
placement and antibiotics, and have excellent resolution rates. While sterile lymphoceles
<10 cm can be successfully managed with drain placement, if drainage and sclerotherapy
fail, laparoscopic unroofing should be considered. For patients with sterile lymphoceles
≥10 cm there should be a shared decision-making process to weigh the risk of a protracted
course if a drain is utilized vs upfront laparoscopic unroofing.
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Article info
Publication history
Published online: June 16, 2020
Accepted:
June 7,
2020
Received:
March 2,
2020
Footnotes
Conflict of Interest: This manuscript has no funding or conflicts of interests to disclose.
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
