THE MANAGEMENT OF RECTAL INJURY DURING RADICAL RETROPUBIC PROSTATECTOMY

被引:71
作者
BORLAND, RN [1 ]
WALSH, PC [1 ]
机构
[1] JOHNS HOPKINS MED INST,JAMES BUCHANAN BRADY UROL INST,BALTIMORE,MD 21205
关键词
RECTUM; WOUNDS AND INJURIES; PROSTATECTOMY;
D O I
10.1016/S0022-5347(17)37418-9
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
From May 1982 through March 1991, 10 rectal injuries were identified in 1,000 men who underwent radical retropubic prostatectomy for clinically localized adenocarcinoma. All rectal injuries occurred in nonirradiated patients. Of these patients 9 were identified during surgery and 1 was diagnosed on postoperative day 2. The 9 patients in whom the injury was recognized at operation underwent successful primary closure without a diverting colostomy. The patient who underwent delayed closure was treated with a temporary diverting colostomy. As a preoperative routine, all patients received a Fleet enema without preoperative antibiotics. In all patients the rectal injury was closed in 2 layers, the anal sphincter was dilated, and a pedicle of omentum was mobilized through a small opening in the peritoneum and placed through the rectovesical cul-de-sac to cover the suture line. All patients received 7 to 14 days of broad-spectrum antibiotics. Postoperatively, no patient had a wound infection, pelvic abscess or urethrorectal fistula. Overall hospital stay was increased by an average of 2 days. Rectal injuries recognized during surgery in previously nonirradiated patients undergoing radical retropubic prostatectomy can be managed successfully with primary closure alone, avoiding the morbidity of a diverting colostomy.
引用
收藏
页码:905 / 907
页数:3
相关论文
共 17 条
[1]   VARIETY OF RECTOURETHRAL FISTULAS - EXPERIENCES WITH 20 CASES [J].
CULP, OS ;
CALHOON, HW .
JOURNAL OF UROLOGY, 1964, 91 (05) :560-&
[2]   SURGICAL MANAGEMENT OF RECTOURINARY FISTULAS RESULTING FROM A PROSTATIC OPERATION - REPORT OF 5 CASES [J].
DAHL, DS ;
HOWARD, PM ;
MIDDLETON, RG .
JOURNAL OF UROLOGY, 1974, 111 (04) :514-517
[3]   MORBIDITY OF RADICAL PERINEAL PROSTATECTOMY FOLLOWING TRANS-URETHRAL RESECTION OF THE PROSTATE [J].
ELDER, JS ;
GIBBONS, RP ;
CORREA, RJ ;
BRANNEN, GE .
JOURNAL OF UROLOGY, 1984, 132 (01) :55-57
[4]   COMPLICATIONS OF CYSTECTOMY [J].
FREIHA, FS .
JOURNAL OF UROLOGY, 1980, 123 (02) :168-169
[5]   RECTOURINARY FISTULA - PRINCIPLES OF MANAGEMENT AND A TECHNIQUE OF SURGICAL CLOSURE [J].
GOODWIN, WE ;
TURNER, RD ;
WINTER, CC .
JOURNAL OF UROLOGY, 1958, 80 (04) :246-254
[7]   MORBIDITY OF RADICAL PROSTATECTOMY FOR MULTIFOCAL STAGE-I PROSTATIC ADENOCARCINOMA [J].
NICHOLS, RT ;
BARRY, JM ;
HODGES, CV .
JOURNAL OF UROLOGY, 1977, 117 (01) :83-84
[8]  
Olsson C A, 1976, Urol Surv, V26, P135
[9]   RADICAL PROSTATECTOMY IN STAGE A PROSTATIC ADENOCARCINOMA [J].
PAULSON, DF ;
ROBERTSON, JE ;
DAUBERT, LM ;
WALTHER, PJ .
JOURNAL OF UROLOGY, 1988, 140 (03) :535-539
[10]   MANAGEMENT OF RECTAL INJURY AND RECTOURETHRAL FISTULAS FOLLOWING RADICAL RETROPUBIC PROSTATECTOMY [J].
SMITH, AM ;
VEENEMA, RJ .
JOURNAL OF UROLOGY, 1972, 108 (05) :778-&