Background: Bowel injury is a devastating complication of radical prostatectomy. The incidence and management of bowel injury occurring during robot-assisted laparoscopic radical prostatectomy (RALP) performed at our institution was reviewed.
Patients and methods: Only three (1.04%) out of 288 RALPs performed at our institution between December 2005 and May 2011 were complicated by bowel injury. The mean patient age was 71 years (range 67 to 79) and mean prostate specific antigen was 19.6 ng/ml (range 6.4 to 30.6). All three patients had received transurethral resection of prostate (TURP) before RALP. Clinical stages were T1b, T1c, T2c, respectively. The mean preoperative Gleason score was 6.7 (range 6 to 7). The mean operative time was 201 minutes (range 170 to 240).
Results: Two of the intraoperative injuries were diagnosed and repaired intraoperatively and one was diagnosed postoperatively. In the two cases of intraoperative diagnosis and repair, one patient healed primarily without colostomy and a recto-urinary fistula was evidenced by pneumaturia in the other. That patient underwent a failed fistula repair and required colostomy. The patient with unrecognized bowel injury presented with atypical acute abdomen and required laparotomy and colostomy. No perioperative mortality occurred in these three cases.
Conclusion: Bowel injury during RALP can be managed intraoperatively; unrecognized bowel injury may present with atypical acute abdomen and dissemination of the presentation and management of bowel injury, and modifications to avoid complications might help to produce improved outcomes in RALP.