RECTAL INJURIES DURING RADICAL PERINEAL PROSTATECTOMY

Objectives. To review a contemporary series of rectal injuries occurri ng during radical perineal prostatectomy. Methods. Of 81 patients who underwent radical perineal prostatectomy, 9 (11%) sustained a full-thi ckness laceration of the anterior rectal wall, All 9 patients had a pr eoperative bowel preparation, although only 1 received a complete oral lavage regimen. All received prophylactic perioperative intravenous a ntibiotics. None had undergone prior surgery to the rectum or perineum or received prior pelvic radiation therapy. Results. In most cases in jury occurred during division of the rectourethralis muscle, but in at least hive instances the injury appeared to be the result of undue po sterior retraction along the rectal wall. All injuries were recognized at the time of surgery and repaired primarily. No patient had associa ted postoperative complications. Conclusions. Rectal injury occurs wit h significantly greater frequency with radical perineal prostatectomy than with the retropubic approach. However, if the rectum is adequatel y prepared, the injury promptly recognized and repaired, and postopera tive care appropriate, the great majority of cases will not lead to at tendant morbidity.