Rectal injuries during radical perineal prostatectomy

To review a contemporary series of rectal injuries occurring during radical perineal prostatectomy.

Of 81 patients who underwent radical perineal prostatectomy, 9 (11%) sustained a full-thickness laceration of the anterior rectal wall. All 9 patients had a preoperative bowel preparation, although only 1 received a complete oral lavage regimen. All received prophylactic perioperative intravenous antibiotics. None had undergone prior surgery to the rectum or perineum or received prior pelvic radiation therapy.

In most cases injury occurred during division of the rectourethralis muscle, but in at least two instances the injury appeared to be the result of undue posterior retraction along the rectal wall. All injuries were recognized at the time of surgery and repaired primarily. No patient had associated postoperative complications.

Rectal injury occurs with significantly greater frequency with radical perineal prostatectomy than with the retropubic approach. However, if the rectum is adequately prepared, the injury promptly recognized and repaired, and postoperative care appropriate, the great majority of cases will not lead to attendant morbidity.