RECTAL INJURY OCCURRING AT RADICAL RETROPUBIC PROSTATECTOMY FOR PROSTATE-CANCER - ETIOLOGY AND TREATMENT

Of 2,21 2 patients who underwent radical retropubic prostatectomy for the treatment of prostate cancer, 27 had documented rectal injuries. A ll but one were detected immediately at the time of surgery and were r epaired; a temporary diverting colostomy was established in 6 patients . Follow-up on these patients ranged from nine to one hundred eighty-f ive months (mean, 68 months). Four patients had fistulas between the r ectum and the urinary tract that required additional surgery. Factors that predisposed patients for intraoperative injury to the rectum incl ude a history of previous pelvic radiation therapy, previous rectal su rgery, and previous transurethral resection of the prostate (P < 0.01) . Higher local tumor stage did not significantly increase the risk of rectal injury at the time of radical retropubic prostatectomy. Preoper ative bowel preparation may obviate colostomy; it may still be necessa ry in high-risk patients with suboptimal local repair.