Rectal Injury During Radical Prostatectomy: Incidence, Management, and Outcomes in Single-Center Experience

Area of Science:

• Urology
• Surgical Oncology
• Gastroenterology

Background:

• Rectal injury (RI) is a rare but significant complication following radical prostatectomy (RP).
• Understanding the incidence, risk factors, and management of RI is vital for patient safety.

Purpose of the Study:

• To assess the incidence, risk factors, management strategies, and outcomes of rectal injury during radical prostatectomy.
• To identify factors influencing postoperative continence and erectile function after RI during RP.

Main Methods:

• Retrospective analysis of 382 patients undergoing radical prostatectomy (2012-2024).
• Intraoperative identification and recording of rectal injury repair techniques.
• Analysis of risk factors including BMI, prior pelvic surgery, and pathological features.
• Evaluation of postoperative continence (pad count) and erectile function (IIEF-5) at 12 months.

Main Results:

• Rectal injury occurred in 2.4% of patients (n=9), with successful intraoperative repair in all cases.
• Higher Body Mass Index (BMI) was found to be protective against rectal injury.
• One patient developed a persistent rectourethral fistula requiring diversion colostomy and experienced severe incontinence.
• The median postoperative 12-month IIEF-5 score was 7.

Conclusions:

• Early intraoperative detection and meticulous surgical repair are essential for managing rectal injury during radical prostatectomy.
• Diagnostic measures like pneumatic testing and rectal wall monitoring can reduce postoperative complications.
• Individualized surgical approaches are important for high-risk patients to improve outcomes after radical prostatectomy.