Lymphocele after Radical Protatectomy? Anyone else?

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unhappycramper
Regular Member


Date Joined Nov 2005
Total Posts : 113
   Posted 3/5/2011 12:42 PM (GMT -6)   
I underwent a nerve-Sparing Radical Prostatectomy January of 2009. I also have a rare Metastatic NET Carcinoid Tumor cancer. I'm still wearing depends,and still no erections. I'm dealing with that. Don't want injections or surgically implanted pumps, I would like to think optimistically that I could get some of this back on my own. This was a very good nerve-sparing of the bundles, robotic surgery.

What I'm concerned about now is a Round Fluid density lesion that showed on a routine cat scan. It is located on the left hemipelvis adjacent to the external iliac vessels, causing mass effect on my bladder measuring 7.5 x 5.9 cm.

The doctor said sometimes this happens after prostatectomies, and either I can do nothing, or go to Interventional Radiology and have it drained.

I think it's putting pressure on my bladder to the point where I have more urgency to urinate,and when I do, I have to find a bathroom within one minute or I will lose it. I saw my Oncologist yesterday,and he told me this sudden urgency to pee could be a UTI, so he did a culture,and I'm awaiting the results.

I was just curious how many more guys have ended up with this lesion post-op. I guess the only way to see it is through a CT, or maybe a PET scan. Coincidentally I had my catheter in for seven weeks post-op and also was sent home with a JP (jackson-pratt) bag to collect fluid leaking from my bladder. You could be one of the best surgeons around, but during any surgery there are risks that can not be controlled. Such is life.

Post Edited (unhappycramper) : 3/5/2011 10:48:40 AM (GMT-7)


Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3892
   Posted 3/5/2011 12:54 PM (GMT -6)   
I had the same (more or less) problem, only my fluid turned into a staph infected abscess, a real mess..Put me back in the hospital for a week..When lymph nodes are removed for biopsy, there is always a chance of this happening..The lymph has no place to go..This occurred 4.5 weeks after my surgery

In my case, on an emergency basis, an interventional radiologist did indeed install a drain using a CAT scanner to position it..Drain was in for a month...I did intravenous antibiotics at home for 6 weeks..Not Fun...
Age 68.
PSA age 55: 3.5, DRE normal.
age 58: 4.5
61: 5.2
64: 7.5, DRE "Abnormal"
65: 8.5, " normal", biopsy, 12 core, negative...
66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
67 4.5 DRE "normal"
68 7.0 3rd biopsy positive, 4 out of 12, G-6,7, 9
RALP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT. 2-15-'11 PSA 0.0

unhappycramper
Regular Member


Date Joined Nov 2005
Total Posts : 113
   Posted 3/5/2011 5:11 PM (GMT -6)   
Fairwind,
Thanks for the reply! Am I right to say your had a JP- Jackson-Pratt fluid bag in for a week to drain the abscess, or are you talking about when you had the original radical prostatectomy they inserted a bag then?

Was your fluid also called a lymphocele, or fluid density mass?

I thought all the radiologist does is to use a guided CT for positioning of fluid lesion,then extract all the fluid then and there. thnx

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3892
   Posted 3/7/2011 12:11 PM (GMT -6)   
My staph infection was labeled "Hospital Acquired" , the whole deal a 1 in a 1000 chance, my surgeon said he had never had it happen before, but was aware it COULD happen..Once installed, I had the abdominal drain and it's collection bag for about a month. It stayed in until the fluid stopped collecting in the bag..Had the fluid, lymph, NOT stopped collecting, the next step was injecting (through the drain) an irritant like hydrogen peroxide that would hopefully cause scarring and stop the leakage..If THAT failed to stop it, a second abdominal operation would be necessary to locate and tie off the leaking lymph duct or ducts...

After my original surgery, I had no abdominal drains. I was discharged the next day and had a smooth and uneventful recovery until 4 weeks later when I came down with "The Stomach Flu" on Friday..By Monday morning I was one sick puppy, vomiting, unable to eat or drink, running a fever. Family doc put me on antibiotics, said come back Wednesday if not better. I went back, he took one look at me and sent me back to see my surgeon who immediately did a CAT scan, spotted the fluid filled abscess.. He called it a "lymphocele"..Sent me to the ER right then and there where an interventional radiologist inserted the drain. An amazing amount of nasty looking fluid poured out of me..Blood and fluid samples were sent off to the lab..I was put on IV antibiotics. Tests came back positive for staph in both blood and draining fluid..The next 48 hours were pretty rough, septic shock and death a possibility..

Since your fluid collection is not infected, there is no urgency involved..They are probably hoping the leakage will stop and the fluid (lymph) will be absorbed by the surrounding tissue. Or they could drain it, but this relieves the pressure and might encourage more leakage...I know my surgeon DREADED the thought of having to go back in and locate and cauterize the leaking ducts..You must realize that the lymph system is the sewer system of the body and a lymphocele can not be tolerated or ignored for long..As I understand it, when they remove lymph nodes with the robot, the machine cauterizes the snipped ducts, sealing them off..As you and I have learned, the process is not perfect..How I acquired the staph infection, no one is willing to say...But the slowly collecting lymph fluid became the perfect incubator..

I hope this description helps you in some way..

unhappycramper
Regular Member


Date Joined Nov 2005
Total Posts : 113
   Posted 3/9/2011 3:13 AM (GMT -6)   
Thank you Fairwind for that detailed description.

I see my Urologist in the morning and will ask his opinion. Since the Fluid mass has decreased in size a few cm's as seen as my last week's CT Scan, he will probably tell me to do nothing. The Urine sample came back NEG. for any UTI's as suspected by my other doctor, so this sudden urgency to get to a bathroom very quickly has been going on for the last three or four months, I always thought this lymphocele or round fluid density mass has something to do with it...maybe doing my kegels for only a year after surgery was not enough to strengthen my pelvic floor muscles to control the flow of the bladder sphincter.

I would hate very much if the draining this lesion might encourage more leakage, so I'm hoping it will get absorbed.

Thanks!

Jerry1
Regular Member


Date Joined Mar 2007
Total Posts : 460
   Posted 3/9/2011 10:50 AM (GMT -6)   
 
 
I also had a large lymphocele after my surgery.  I needed to have the cathether in an additional two weeks but did not have it drained beause the surgeon felt it would resolve on its own and draining it could lead to the risk of infection.  It took a few months to resolve but slowly got smaller and smaller.  I also had surgical clips in my bladder that added to pain and burningand urgency.  They also were treating me for a UTI and the whole time it was the clips which they eventually had to remove.  My surgeon who is one of the top robotic surgeons in the county said this also is common.  The good news is I am completely dry. 
 
Jerry1

Age 71 DX 8/13/08, PSA 4.0 Biopsy 14 samples , 1 positive, Gleason 4+4 - Da Vinci 10/17/08 organ confined, no positive margins or lymph nodes, both nerve bundles taken. Gleason 4+4, PT2A
Cath out 10/29/08 dry 11/19/08
First PSA 3/6/09 >0.1- 3/6/09 0.0, 6/3/09 0.1, 10/15/09 0.3, 12/14/09 0.5. IMRT 1/18/10 First PSA 1.5, 7/8/10 1.9, (not good IMRT a failure)
9/3/10 2.4 11/2/10 3.3 1/7/11 3.5

unhappycramper
Regular Member


Date Joined Nov 2005
Total Posts : 113
   Posted 3/9/2011 6:08 PM (GMT -6)   
Jerry1,
Did at any point your doctor ever say that the Lymphocele (fluid density mass) was causing any type of urgency to get to the bathroom as quickly as you can?

Fairwind commented on this site that he contracted a Staph infection. I saw my uro doc today, and he told me that draining, there could always be a chance of infection, then anti-biotics would help that out.

We both looked at the CT of the Pelvis, and looking at the empty bladder, this fluid mass or lymphocele was about three times the size if the bladder. He also told me there is also a good chance that if we went ahead and had it drained, it may have less effect on the pressure onto the bladder,but there's always a chance it can fill up again. So what to do.


Maybe this should have it's own topic, but here it is anyway~
It's been two years,two months since post op, and I told him I'm still wearing diapers, and still no erections. I asked if we had another sit down in two more years and nothing has come back, then he told me that's the way I'm going to stay. Nerve -sparing for one person could be much different than the next, depending how involved the nerve bundles are with cancer. He feels bad for me, and keeps wanting me to do the implant thang, or at least TRIMEX injections. I told him, if I knew I would have ED and incontinence problems post-op, I would have thought twice about the surgery, being that most tell me the chances of actually dying from this cancer is pretty low. Then again, if I not had the surgery, he also would have not found a carcinoid tumor in the nerves, and that could have metastasized.

I'm trying to stay positive and upbeet, but having normal sexual function prior to the surgery, and now after two years not having any at all, it just tears me up, and I am feeling less of a man, especially him telling me it will not be 100% ever again.

Dave7
Regular Member


Date Joined Jul 2006
Total Posts : 202
   Posted 3/9/2011 6:27 PM (GMT -6)   
I have two of these things showing on an MRI taken about 2 years after surgery.  Round white things, easily the size of tennis balls.
 
My urologist told me that unless they were bothering me, I didn't need to do anything.  I haven't done anything about them, but I'm thinking of getting another MRI to see of they have changed.  I do have to urinate frequently, but figured that was due to the removal of my main sphincter during surgery.  I mave have one pushing on my bladder too.
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