There is a paucity of data to guide treatment decisions for symptomatic lymphoceles after radical prostatectomy. We examined our experience to create a treatment algorithm.
We evaluated all patients that underwent radical prostatectomy at our institution from 2003-2012. Presenting signs, management and treatment outcomes were evaluated.
Of the 8,081 patients who underwent radical prostatectomy from 2003-2012, we identified 123(1.5%) patients who developed a symptomatic lymphocele, 70 sterile and 53 infected. Percutaneous aspiration was performed in 26/123 (21%) patients, of those, 100% recurred. A drain was placed in 86/123 (70%) patients for a median of 13 vs 33 days for the infected and sterile lymphocele groups, respectively (p<0.001). The median duration of drainage for sterile lymphoceles was 15 vs 58 days for lymphoceles <10cm vs ≥ 10cm (p<0.001). Percutaneous drainage was successful in 93% and 86% of patients with infected and sterile lymphoceles, respectively. Laparoscopic unroofing was performed in 18 sterile lymphocele patients (15%) with a success rate of 94%.
Aspiration of symptomatic lymphoceles should be reserved for diagnostic purposes due to a high risk of recurrence. Infected lymphoceles are optimally treated with drain placement and antibiotics, and have excellent resolution rates. While sterile lymphoceles <10cm can be successfully managed with drain placement, if drainage and sclerotherapy fail, laparoscopic unroofing should be considered. For patients with sterile lymphoceles ≥ 10cm there should be a shared decision-making process to weigh the risk of a protracted course if a drain is utilized vs upfront laparoscopic unroofing.

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