Case profile: Unusual complications of radical perineal prostatectomy

URORADIOLOGY

CASE PROFILE:

UNUSUAL COMPLICATIONS PERINEAL

PROSTATECTOMY

In 1972 a sixty-four-year-old white man underwent a radical perineal prostatectomy for Stage B carcinoma. Until the fall of 1976 he was well, having only minor stress incontinence. At that

FIGURE 1.

A diverticulectomy was accomplished through a perineal approach. The neck of the diverticulum was intimately attached to the urethra, and dissection was stopped at this point. The

(A) Preoperative and (B) postoperatiue voiding cystourethrogram.

time he presented complaining of a perineal mass and some perineal drainage. On physical examination the patient was found to have a large fluctuant perineal mass with a small draining sinus at its apex. Rectal examination showed no evidence of recurrent carcinoma. A voiding cystourethrogram demonstrated a large perineal diverticulum (Fig. 1A). At cystoscopy the urethra was found to be normal. There was no prostatic regrowth. The opening of the fistula was identified at the bladder neck, midway between the ureteral orifices.

UROLOGY

OF RADICAL

/ JANUARY 1978 / VOLUME

XI, NUMBER

1

Foley was removed at fourteen days. The patient’s continence was unaltered and a postoperative voiding cystourethrogram was accomplished (Fig. 1B). Ralph deVere White, M.D. Lawrence Cleeve, M.D. John Weinerth, M.D. Department of Surgery Division of Urologic Surgery Duke University Medical Center Durham, North Carolina 27710

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