Earlier this 12 months, US Secretary of Defense Lloyd Austin was hospitalized with complications from prostate cancer surgery. Details of her procedure, which was performed on December 22, weren’t fully disclosed. Pentagon press statements indicated that Austin had undergone a minimally invasive prostatectomy, an operation to remove the prostate gland. The minimally invasive procedure is performed using robotic instruments passed through a small “keyhole” incision within the patient's abdomen.
Just every week later, Austin developed severe abdominal, hip, and leg pain. He was admitted to Walter Reed Hospital's intensive care unit on January 2 for monitoring and further treatment. Doctors discovered that Austin had a urinary tract infection and a fluid build-up in his abdomen that was disrupting bowel function. The defense secretary was successfully treated, but was readmitted to the ICU on February 11 for what the Pentagon described as an “emerging bladder problem.” After two days of what was described only as a “non-surgical procedure performed under general anesthesia,” Austin was back at work. His cancer prognosis is claimed to be excellent.
How common are urinary tract infections after prostatectomy?
Minimally invasive prostatectomy is mostly well tolerated. In one the study that examined complications in greater than 29,000 men who underwent the operation, the urinary tract infection rate was only 2.1 percent. The risk of sepsis – a more serious condition that happens when the body's response to an infection damages other organs – is way lower.
How does a urinary tract infection occur?
Although urinary tract infections are rare after prostatectomy, bacteria can travel through the catheter into the urinary system. An essential a part of a prostatectomy involves connecting the urethra — which is the tube that carries urine out of the body — directly from the bladder after the prostate has been removed. As the ultimate step in the method, we pass a catheter. [a soft silicone tube] Through the urethra and into the bladder to advertise healing. Giving antibiotics each during surgery and again one to 2 weeks after the operation before the catheter is removed reduces the danger of infection.
How do you treat urinary tract infection complications once they occur?
It isn’t unusual to seek out small amounts of bacteria within the urine each time you utilize a catheter. Usually they don't cause any symptoms, but when infectious complications develop, we are going to admit the patient to the hospital and treat them with broad-spectrum antibiotics that treat many differing types of bacteria at the identical time. . We can even obtain a urine culture to discover the bacterial species causing the infection. Based on the culture results, we will switch to different antibiotics that specifically attack these microbes. The duration of treatment will likely be 10 to 14 days.
Lloyd Austin also had gastrointestinal complications. Why might this have happened?
While I can't speculate about Austin's specific case, gastrointestinal complications are generally rare – affecting lower than 2% of patients treated with robotic methods. However, things will be just a little different. For example, the small intestine may “go to sleep” after surgery, meaning it temporarily stops moving food and waste through the intestines.
This is named ileus. This can occur for numerous reasons, including consequently of anesthetic or pain medication. An ileus often resolves by itself if the patient abstains from food or water by mouth for several days. If this causes an excessive amount of pressure within the intestines, we “decompress” the stomach by draining the amassed fluids through a nasogastric tube, which is inserted through the nose and throat into the stomach.
Some patients develop a special variety of surgical complication called small bowel obstruction. We treat them the identical way: by withholding food and water by mouth and draining fluids with a nasogastric tube if essential. If the obstruction is attributable to scar tissue, in rare cases one other surgery could also be needed to repair the obstructing scar tissue.
Fluid may also accumulate within the pelvis after lymph nodes are removed during surgery. What is occurring in these cases?
Pelvic lymph nodes that drain the prostate are frequently removed during a prostatectomy to find out if any cancer has spread to the lymph nodes. A possible risk with lymph node removal is that lymph fluid can leak out and collect within the pelvis after the procedure. This is named a lymphocele. Most lymphoceles are asymptomatic, but occasionally they’ll turn into infected. When this happens, we treat with antibiotics, and we will drain the lymphocele using a percutaneous catheter. [which is placed through the skin]. Fortunately, recent surgical techniques are helping to be certain that lymphoceles are rare.
Are there individual aspects that increase the danger of prostatectomy complications?
Certainly, patients could have risk aspects for infection. Diabetes, for instance, can suppress the immune system, especially when patients have poor glycemic or glucose control. [a limited ability to maintain normal blood sugar levels]. If patients have autoimmune diseases, or in the event that they are taking immunosuppressants, they can also be at increased risk of infectious or wound healing complications with surgery, and in some cases these risks could also be avoided. It will be treated with radiation.
Thanks for walking me through this complicated topic! Any parting thoughts for our readers?
It is essential to debate the potential risks of surgery along with your doctor so that you just are fully informed. That said, prostatectomy using a minimally invasive procedure as of late has a really favorable risk profile. The majority of patients do very well, and fortunately serious complications requiring hospitalization are rare.