Bleeding can occur due to several reasons including blunt lateral dissection, poor control of the deep dorsal venous complex (DVC), pelvic floor and nerve sparing. There are several ways to cope with bleeding. This includes suturing the DVC to the periost, and by using a balloon catheter to stop bleeding by using traction and adhering it to the bleeding site.
Ureteral injury can occur during bladder neck transection, or posterior bladder wall dissection, or pelvic lymph node dissection (PLND). The most important thing is to recognize the injury, and catheterize the orifices before bladder neck reconstruction.
Early postoperative bleeding can be managed by embolization with histoacryl/lipiodol. Lympocele and lymohedema can occur especially when performing super extended PLND. It is important to open the peritoneum when performing PLND, to allow resorption. The drain should be removed when the output is less than 20 ml, and after checking the absence of creatinine in it. Small asymptomatic lymphoceles are very common. Large symptomatic lymphoceles need percutaneous drainage. For recurrent lasting lymphoceles, it is possible to consider performing laparoscopic deroofing.
Intractable anastomotic strictures can occur when there is partial disruption of the anastomosis, when there is urinary extravasation, and excessive perioperative blood loss causing decreased visualization or hematoma.
In summary, ORP is generally a safe procedure. Most complications are avoidable by using meticulous surgical technique, however some are unavoidable. Most are easy to manage, especially if early recognition is performed. In postoperative complications, it is almost always possible to avoid taking the patient back to the OR and manage him conservatively. However, some complications are extremely severe (rare) and require complex reconstructive surgery by an experienced team.
Presented by: Steven Joniau, Leuven, Belgium
Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, twitter: @GoldbergHanan at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark