[Lymphoceles after radical retropubic prostatectomy. A treatment algorithm]

Abstract

Lymphoceles represent a common complication following pelvic lymphadenectomy and radical retropubic prostatectomy. Relevant articles published in the last 25 years and our own results based on a prospective study were taken as the basis for a treatment algorithm for lymphoceles after radical prostatectomy.The type of intervention depends on the clinical situation of the patient. Symptomatic lymphoceles can be managed initially by percutaneous aspiration with or without instillation of sclerosing agents. However, lymphocele recurrence rates are high. Symptomatic, sterile lymphoceles appear to be ideally suited for drainage by laparoscopic techniques. This method is effective, usually immediately definitive, results in minimal patient morbidity, and allows for a more rapid recovery. Infected lymphoceles require percutaneous or open surgical drainage. Laparoscopic marsupialization of symptomatic lymphoceles after pelvic lymphadenectomy for prostate cancer appears to be safe and effective. Because of the minimal postoperative morbidity, rapid convalescence, and low recurrence rate, laparoscopic lymphadenectomy should be considered as a first-line treatment for symptomatic, uninfected sterile lymphoceles.