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Delayed bilateral obturator nerve injury due to compressing bilateral pelvic lymphoceles after robot-assisted laparoscopic radical prostatectomy and bilateral lymphadenectomy for prostatic carcinoma

A clinically significant obturator nerve injury is uncommon after robot-assisted radical prostatectomy and lymphadenectomy. If the injury is due to a direct intraoperative event such as transection or stretching of the nerve, the patients present typically in the immediate postoperative period. On t...

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Autor principal: Aljomaa, Ayman
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6057161/
https://www.ncbi.nlm.nih.gov/pubmed/30090750
http://dx.doi.org/10.4103/ajm.AJM_215_17
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author Aljomaa, Ayman
author_facet Aljomaa, Ayman
author_sort Aljomaa, Ayman
collection PubMed
description A clinically significant obturator nerve injury is uncommon after robot-assisted radical prostatectomy and lymphadenectomy. If the injury is due to a direct intraoperative event such as transection or stretching of the nerve, the patients present typically in the immediate postoperative period. On the other hand, an indirect injury through compression of the nerve through a pelvic fluid collection (hematoma or lymphocele) progresses insidiously and delays the presentation of these patients making a dilemma in recognizing these patients and differentiating them from those with other causes of neurological deficits. A delay in the correct management of the compressing collections may negatively affect the neurological function of the patient. We demonstrate a 61-year-old male who presented with pain and motor weakness of obturator origin 1 week after robot-assisted radical prostatectomy and lymphadenectomy for prostatic cancer. The computed tomography scan showed bilateral pelvic lymphoceles possibly compressing the obturator nerves. The neurological function has improved after evacuation of these collections. This case emphasizes the importance of considering delayed postsurgical compression of the obturator nerve in our differential diagnosis when patients present with typical signs and symptoms of obturator nerve injury after robot-assisted radical prostatectomy and lymphadenectomy. Early diagnosis and evacuation of these collections would improve the neurological outcome.
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spelling pubmed-60571612018-08-08 Delayed bilateral obturator nerve injury due to compressing bilateral pelvic lymphoceles after robot-assisted laparoscopic radical prostatectomy and bilateral lymphadenectomy for prostatic carcinoma Aljomaa, Ayman Avicenna J Med Case Report A clinically significant obturator nerve injury is uncommon after robot-assisted radical prostatectomy and lymphadenectomy. If the injury is due to a direct intraoperative event such as transection or stretching of the nerve, the patients present typically in the immediate postoperative period. On the other hand, an indirect injury through compression of the nerve through a pelvic fluid collection (hematoma or lymphocele) progresses insidiously and delays the presentation of these patients making a dilemma in recognizing these patients and differentiating them from those with other causes of neurological deficits. A delay in the correct management of the compressing collections may negatively affect the neurological function of the patient. We demonstrate a 61-year-old male who presented with pain and motor weakness of obturator origin 1 week after robot-assisted radical prostatectomy and lymphadenectomy for prostatic cancer. The computed tomography scan showed bilateral pelvic lymphoceles possibly compressing the obturator nerves. The neurological function has improved after evacuation of these collections. This case emphasizes the importance of considering delayed postsurgical compression of the obturator nerve in our differential diagnosis when patients present with typical signs and symptoms of obturator nerve injury after robot-assisted radical prostatectomy and lymphadenectomy. Early diagnosis and evacuation of these collections would improve the neurological outcome. Medknow Publications & Media Pvt Ltd 2018 /pmc/articles/PMC6057161/ /pubmed/30090750 http://dx.doi.org/10.4103/ajm.AJM_215_17 Text en Copyright: © 2018 Avicenna Journal of Medicine http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Case Report
Aljomaa, Ayman
Delayed bilateral obturator nerve injury due to compressing bilateral pelvic lymphoceles after robot-assisted laparoscopic radical prostatectomy and bilateral lymphadenectomy for prostatic carcinoma
title Delayed bilateral obturator nerve injury due to compressing bilateral pelvic lymphoceles after robot-assisted laparoscopic radical prostatectomy and bilateral lymphadenectomy for prostatic carcinoma
title_full Delayed bilateral obturator nerve injury due to compressing bilateral pelvic lymphoceles after robot-assisted laparoscopic radical prostatectomy and bilateral lymphadenectomy for prostatic carcinoma
title_fullStr Delayed bilateral obturator nerve injury due to compressing bilateral pelvic lymphoceles after robot-assisted laparoscopic radical prostatectomy and bilateral lymphadenectomy for prostatic carcinoma
title_full_unstemmed Delayed bilateral obturator nerve injury due to compressing bilateral pelvic lymphoceles after robot-assisted laparoscopic radical prostatectomy and bilateral lymphadenectomy for prostatic carcinoma
title_short Delayed bilateral obturator nerve injury due to compressing bilateral pelvic lymphoceles after robot-assisted laparoscopic radical prostatectomy and bilateral lymphadenectomy for prostatic carcinoma
title_sort delayed bilateral obturator nerve injury due to compressing bilateral pelvic lymphoceles after robot-assisted laparoscopic radical prostatectomy and bilateral lymphadenectomy for prostatic carcinoma
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6057161/
https://www.ncbi.nlm.nih.gov/pubmed/30090750
http://dx.doi.org/10.4103/ajm.AJM_215_17
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