Transient Lower Extremity Neurapraxia Associated With Radical Perineal Prostatectomy: A Complication of the Exaggerated Lithotomy Position

Price, David T.; Vieweg, Johannes; Roland, Frank; Coetzee, L.; Spalding, Thomas; Iselin, Christophe; Paulson, David F.

doi:10.1016/s0022-5347(01)62541-2

Cited by 49 publications

(13 citation statements)

References 14 publications

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“…Older age, inappropriate lithotomy position, and especially prolonged operation time are thought to be the main risk factors for developing these complications (Anema et al 2000; Gumus et al 2002; Price et al 1998; Hindley & Watson 2007). Our patient (case 15) seem to develop neurapraxia and rhabdomyolysis in direct proportion to the duration of the exaggerated positioning.…”

Section: Resultsmentioning

confidence: 99%

Hybrid procedure using perineal and abdominal approaches for radical prostatocystectomy: initial experience with 16 select cases

et al. 2013

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ObjectivesTo validate the feasibility and implications of a hybrid procedure using perineal and abdominal approaches for a radical prostatocystectomy.MethodsBetween March 2007 and May 2012, we performed 16 prostatocystectomy and simultaneous urethrectomy under a hybrid procedure using perineal and abdominal approach for advanced bladder cancer. The hybrid procedure was selected in each case, because of prostatic urethra involvement in 13 and prior treatment in 3 (irradiation, radical retropubic prostatectomy, and sigmoidectomy, respectively). Two surgical teams, one responsible for the perineal approach and the other for the abdominal portion, performed the operation.ResultsThe median operation time for the prostatocystectomy procedure was 207 minutes and median intraoperative blood loss was 1665 ml. The en bloc removal of the specimen was perfectly performed and no intraoperative difficulties and intraoperative complications such as rectal injury were recognized in all cases. As for postoperative complications associated with the exaggerated lithotomy position, neurologic complications and rhabdomyolysis which could be treated conservately were found in 1 case. Although 5 patients died from distant metastasis, local recurrence was not seen in any of the 16 patients during the follow-up period.ConclusionThe hybrid procedure using perineal and abdominal approach for radical prostatocystectomy is a well-organized procedure that can provide good visualization of the surgical structure around the prostate, leading to a reduction in or prevention of local recurrence and surgical complications even in the selected patient.

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Section: Resultsmentioning

confidence: 99%

Hybrid procedure using perineal and abdominal approaches for radical prostatocystectomy: initial experience with 16 select cases

et al. 2013

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“…The 2 cases of transient lower extremity neuropraxia deserve special consideration: Contributing factors that may increase the likelihood of this complication are greater difficulty in positioning these large patients in the exaggerated lithotomy position, increased weight of the lower extremities and prolonged operative time. 7,16 Prior to surgery it would be practical to test the ability of morbidly obese patients to assume the exaggerated lithotomy position. Furthermore, perineal surgeons should be aware of the potential risk of rhabdomyolysis and subsequent acute renal failure as a result of maintaining patients in an exaggerated lithotomy position for a prolonged period.…”

Section: Methodsmentioning

confidence: 99%

Radical Perineal Prostatectomy for the Treatment of Localized Prostate Cancer in Morbidly Obese Patients

et al. 2005

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“…Doblet et al (5) , studying 24 patients operated by perineal technique, described 3 cases of rectal lesion, and only one case in a group of 16 patients operated by the suprapubic technique. Other studies showed higher rates of rectal lesion in perineal prostatectomy, and mentioned it was the most serious complication (12)(13)(14) . The occurrence of urinary fistula has been reported in all studies and for both techniques.…”

Section: Introductionmentioning

confidence: 95%

Comparative analysis of radical prostatectomy techniques using perineal or suprapubic approach in the treatment of localized prostate cancer

Amorim

Cruz

Veloso

et al. 2010

Einstein (São Paulo)

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Objective: To compare the results of radical prostatectomy by perineal and suprapubic approaches as to operative time, procedure costs, and surgical site complications. Methods: The medical records of localized prostate cancer patients (PSA ≤ 10 ng/ml and Gleason score ≤ 6) were analyzed. Fifty-five patients were submitted to radical prostatectomy by perineal approach and 54 via suprapubic approach. results: There were statistical differences between groups as to operative time (p < 0.05); for perineal approach it was in average 114 minutes (SD ± 0.03) and for suprapubic approach, an average of 167 minutes (SD ± 0.041). Prostatectomy via perineal approach resulted in 11 cases of surgical complications, and suprapubic approach, 3 cases. conclusions: Radical prostatectomy via perineal approach took less time at a lower cost as compared to the suprapubic approach. However, there were more complications in patients submitted to perineal approach, mainly rectal lesions.Keywords: Prostatectomy/methods; Prostatectomy/economics; Prostatectomy/adverse effects; Prostatic neoplasms reSUMO Objetivo: Comparar os resultados da prostatectomia radical por acesso perineal e por via suprapúbica quanto ao tempo operatório, custo de realização do procedimento e complicações do sítio cirúrgico. Métodos: Foram analisados os prontuários de pacientes com câncer de próstata localizados (PSA ≤ 10 ng/ml e escore de Gleason ≤ 6) sendo 55 submetidos à técnica de prostatectomia perineal e 54 à técnica suprapúbica (PRSP). resultados: Houve diferença estatística entre os grupos quanto ao tempo operatório (p < 0,05). O tempo médio para a realização de todo o ato operatório por acesso perineal foi 114 minutos em média (DP ± 0,03) e de 167 minutos em média (DP ± 0,041) quando empregado o acesso suprapúbico. O índice de complicações cirúrgicas decorrentes das prostatectomias realizadas foi de 11 casos na prostatectomia radical perineal e de 3 casos submetidos à técnica suprapúbica. conclusões: A prostatectomia radical pelo acesso perineal foi realizada em menor tempo com menor custo do procedimento quando comparada à operação realizada pelo acesso suprapúbico. Entretanto, relacionou-se a maior incidência de complicações em comparação ao acesso suprapúbico, principalmente com relação à lesão retal.

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Transient Lower Extremity Neurapraxia Associated With Radical Perineal Prostatectomy: A Complication of the Exaggerated Lithotomy Position

Abstract: Careful attention to detail when positioning the patient and limiting the time in the exaggerated lithotomy position appear to be the most critical aspects to prevent neurapraxia.

Cited by 49 publications

References 14 publications

Hybrid procedure using perineal and abdominal approaches for radical prostatocystectomy: initial experience with 16 select cases

Hybrid procedure using perineal and abdominal approaches for radical prostatocystectomy: initial experience with 16 select cases

Radical Perineal Prostatectomy for the Treatment of Localized Prostate Cancer in Morbidly Obese Patients

Comparative analysis of radical prostatectomy techniques using perineal or suprapubic approach in the treatment of localized prostate cancer

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