Cutting Edge Urology

T his PDF belongs to matthew.hooson@springer.co ROBOTIC SIMPLE PROSTATECTOMY • 17  Potential Complications The most common complication from this procedure is ongoing hematuria. This can lead to prolonged CBI, prolonged length of stay, and even potential clot retention and possible bladder rupture. The best way to avoid this is to spend the necessary amount of time in the operating room to get perfect hemostasis prior to bladder closure. If there is persistent ongoing hematuria which looks arterial, it may become necessary to take the patient back to the operating room. Often it is a simple matter to address this cystoscopically and fulgurate the arterial bleeder with a resectoscope loop. Rarely, if the urethral catheter gets blocked and is not recognized in a timely fashion, the bladder closure may give way and there can be an intraperitoneal leak. In this situation, the best approach is to go back robotically, open the bladder, wash it out, get hemostasis, and close the bladder again. Transient incontinence and erectile dysfunction can occur rarely, in less than 5% of patients. Some patients have symptoms of overactive bladder and dysuria for a few weeks to months after surgery. Most of these are self-limiting and resolve spontaneously. Rarely, if residual adenoma is left behind at the apex, patients may not be able to void well postoperatively. This can be diagnosed at the 3-month visit and confirmed with an office cystos- copy. Residual adenoma at the apex associated with poor flow and high IPSS score can be treated with a TURP directed at this residual tissue. Follow-up Intermittent compression stockings and subcutaneous heparin are used during the hospital stay to prevent thromboembolic events. Continuous bladder irrigation is stopped on the first post- operative day if the urine is clear or light pink. The JP drain is removed prior to discharge after confirming absence of urine leak. The median lengt of hospital stay in our experience is 3 days. The urethral catheter is removed on postoperative day 7 with a voiding trial. A follow-up visit is scheduled at 3 months for symptom check, uroflowmetry, postvoid residual urine measurement, and administration of IPSS and SHIM questionnaires. References 1. McVary K T, Roehrborn CG, Avins AL , Barry MJ, Bruskewitz RC, Donnell RF, et al . Update on AUA guideline on the managem ent of benign prostati c hyperplasia. J Urol. 2011;185(5):1793–803. 2. Oelke M, Bach mann A, Desca zeaud A, Emberton M, Gravas S, Michel MC, et al . EAU guidelines on the treatment and follow-up of non-neu rogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol. 2013;64(1): 118 –40. 3. Parsons JK, Rangarajan SS, Palazzi K, Chang D. A national, comparative analysis of perioperative outcomes of open and minimally invasive simple prostatectomy. J Endourol. 2015;29(8):919–24. 4. Autorino R, Zargar H, Mariano MB, Sanchez-Salas R, Sotelo RJ, Chlosta PL, et al . Perioperative outcomes of robotic and laparoscopic simple prostatectomy: a European-American multi-institutional analysis. Eur Urol. 2015;68(1):86–94. 5. Mariano MB, Graziottin TM, Tefilli MV. Laparoscopic prostatectomy with vascular control for benign prostatic hyperplasia. J Urol. 2002;167(6):2528–9. Cutting EDGE_Urology(SUN)_final.indd 17 27-Mar-18 10:00:28 AM