Erdem KOÇ, Bahri GÖK, Davut KAMACI, Erem ASİL, Ali Fuat ATMACA

Robotik radikal prostatektomi sonrası dev lenfosele bağlı gelişen bilateral hidronefroz

Lenfosel, pelvik lenf nodu diseksiyonu sonrası meydana gelen en sık komplikasyondur ve genellikle postoperatif 2.-12. aylarda görülmekle birlikte subklinik seyreder. Biz bu olgu sunumunda, robot yardımlı radikal prostatektomi (RYRP) ve genişletilmiş pelvik lenf nodu diseksiyonu sonrası oluşan dev lenfosele bağlı olarak gelişen bilateral hidronefroz vakasını sunmayı amaçladık. Robotik radikal prostatektomi ve genişletilmiş pelvik lenf nodu diseksiyonu sonrası postoperatif 7. günde çekilen sistografide mesanenin sol tarafa deviye izlenmesi nedeniyle kontrastsız bilgisayarlı tomografi (BT) çekildi. BT’de sağ pelvik bölgede bilateral hidronefroz ve dev lenfosel izlendi. Lenfoselin perkütan kateter drenajı sonrasında hastanın klinik durumu dramatik şekilde düzeldi. Bu olgu, dev lenfosele bağlı olarak ortaya çıkan bilateral hidronefrozun görülmesi, artmış kreatinin seviyesine rağmen asemptomatik seyretmesi ve transperitoneal cerrahi sonrası erken dönemde gelişmesi açısından literatürdeki ilk vaka olması nedeniyle önem taşımaktadır. Bununla birlikte, lenfoselin perkütan kateter drenajıyla bulgular dramatik bir şekilde düzelebilmektedir.

Anahtar Kelimeler:

Hidronefroz, Lenfosel, Prostat kanseri, Robotik cerrahi

Bilateral hydronephrosis subsequent to a giant lymphocele after robotic radical prostatectomy

Lymphocele, one the most common complications after pelvic lymph node dissection, is usually observed between postoperative 2nd-12th months as a subclinical complication. We aimed to present a bilateral hydronephrosis case resulting from a giant lymphocele which developed during the early postoperative period after robot assisted radical prostatectomy (RARP) and pelvic lymph node dissection. Cystography was performed on the 7th postoperative day following RARP and extended lymph node dissection. Due to the left sided deviation of the bladder in cystographic images, non-contrast computed tomography (CT) was obtained, which revealed bilateral hydronephrosis and a giant lymphocele in the right pelvic region. The clinical status improved dramatically after percutaneous catheter drainage of the lymphocele. To the best of our knowledge, this is the first bilateral hydronephrosis case in the literature, which developed due to a giant lymphocele that occurred during the early postoperative period after transperitoneal surgery and had an asymptomatic clinical course despite increased creatinine levels. The findings improved dramatically by percutaneous catheter drainage.

Keywords:

Hydronephrosis, Lymphocele, Prostate carcinoma, Robotic surgery,

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