What complications may occur after prostatectomy?

Complications after prostate surgery can be divided into two categories: early complications and late complications. Early complications include shock and acute renal failure. It happened within 48 hours after the operation. Late complications related to surgery or anesthesia include urethral stricture, urinary incontinence and fistula formation. It happened in the course of rehabilitation 48 hours after operation. Some complications can occur within 48 hours after operation, such as bleeding. Common postoperative complications are as follows.

(1) Bleeding is an early postoperative complication. The main causes of postoperative bleeding in prostate are: unreliable bleeding at the edge of prostate fossa; Three-lumen and two-sac tubes slip or rupture; Overfilling and spasm of bladder and obstruction of venous return; Excessive defecation at the beginning of extubation. Generally, it is a small amount of bleeding, and no special treatment is needed. In case of massive bleeding, effective treatment measures should be actively taken, such as incision of bladder to stop bleeding again or hemostasis under electrotome microscope again.

(2) There are many chances of urinary tract infection after operation, but if urine culture is done well before operation, sensitive drugs are used, aseptic operation is strictly performed during operation, and antibiotics are used correctly after operation, serious infection will generally not occur.

(3) Seminal canal infection refers to epididymitis and seminal vesiculitis, mostly retrograde infection. The way to prevent seminal duct infection is to make a good diagnosis and treatment of urinary tract infection before operation, shorten the time of indwelling catheter and take preventive vasectomy when necessary; Pay attention to protect seminal vesicle and keep the opening of ejaculatory duct intact during operation. In recent years, postoperative vas deferens infection is rare.

(4) Urinary fistula is secondary to poor wound healing and lower urinary tract obstruction. Poor wound healing is related to malnutrition, wound infection and wound fat liquefaction. To prevent urinary fistula, besides incision infection, all causes of lower urinary tract obstruction should be removed. The indwelling drainage tube should be kept clear, and the suprapubic ostomy tube should be far away from the bladder neck and close to the top of the bladder.

(5) Dysuria The types and causes of dysuria after prostatectomy are different.

(6) Urinary incontinence is caused by surgical injury to external urethral sphincter or smooth muscle around bladder neck and prostate. The key to prevent postoperative urinary incontinence lies in the technical operation in prostatectomy.

(7) Urethral rectocele fistula is common in perineal prostatectomy, and occasionally in suprapubic, retropubic or transurethral prostatectomy. The main reasons are: injury to rectal wall during operation; Postoperative pelvic floor infection and poor drainage. The main preventive measures are: careful operation and clear anatomy during operation to avoid rectal injury; If rectal injury is found during operation, it should be repaired immediately: broad-spectrum antibacterial drugs should be used after operation.

(8) Pubic osteomyelitis is a rare complication after prostatectomy. Most of them occur after retropubic prostatectomy, and the preventive measures are: completely cure urinary tract infection before operation; Pay attention to protect the pubic periosteum during operation to avoid extensive dissection of retropubic space; Drainage retropubic space correctly.

(9) Sexual dysfunction is one of the complications after prostatectomy. The main reason may be that the nerve controlling penile erection is damaged or the vein leading to genitalia is also damaged.

(10) Urine extravasation is more common in retropubic or perineal prostatectomy.