Lymphoceles: Side Effect of Robot Assisted Laparoscopic Radical Prostatectomy

I recently wrote an article about the immediate unexpected side effects of a robot-assisted laparoscopic radical prostatectomy (RALP), titled, "Radical Robotic Laparoscopic Prostatectomy: What I Didn’t Know About Early Recovery". I cited the side effects I experienced in April 2018 and the side effects experienced by a friend after surgery in October 2020: bloating, painful and weeping incisions, abdominal and chest cavity pain from CO2 used during the surgery, and catheter discomfort.

Since writing that article, I’ve learned about another side effect: pelvic lymphoceles resulting from the routine pelvic lymph node dissection (PLND) that occurs during surgery.

The collection of lymphatic fluid

After much research, my friend chose to travel to a famous hospital on the east coast to have his surgery done by a surgeon with an excellent national reputation, an expert on using the Da Vinci robot. As I mentioned above, he experienced much the same side effects that I experienced in 2018. But one other side effect afflicted him. “I developed a 9cm lymphocele between my left hip and my pelvic bone. Nine centimeters is 3.5 inches, the size of an apple.”

The possibility of this side effect had never been mentioned in any of his consultations before the surgery. According to a November 2016 article posted by the US National Library of Medicine and the National Institutes of Health¹:

“A lymphocele is a collection of lymphatic fluid occurring after surgical dissection as a result of inadequate closure of the afferent lymphatic vessels. Pelvic lymphoceles are a known complication of concomitant pelvic lymph node dissection and radical prostatectomy. While up to 15% of patients treated by radical prostatectomy may develop postoperative pelvic lymphoceles, only 2.6% of these are symptomatic. Symptomatic patients usually present with pelvic bloating, lower abdominal pain, increased urinary frequency, and lower limb edema, all of which can be attributed to the mass effect of the lymphoceles on the adjacent pelvic organs and veins.”

The reality of this side effect

My friend reported similar discomfort in an email to me. “It was pressing on my bladder. I had to pee quite often. When I did pee, it hurt like hell. And there always felt like there was poop in the chute. Additionally, while I was encouraged to return to exercise, walking for more than about 30 minutes caused extreme pain and weakness in my left hip and leg. Once I rested for a short time, the pain would go away, but it was so bad that my left leg would barely support me.”

Draining the lymphocele

According to the article cited above, the initial treatment for a lymphocele is “a CT-guided percutaneous drainage...to drain the pelvic lymphoceles secondary to PLND.”¹ Drainage tubes are placed that are removed at a later date.

Again, my friend’s experience was consistent with the treatment mentioned in the article. “I returned to the hospital to have my lymphocele drained. I have a drain in there for several days until the lymphocele stops draining less than 10cc’s a day for two days. Then I have the drain removed.”

Kegel exercises for recovery

In his email to me, my friend also reported good news. “I have regained continence. A tiny drop squeaks out once every few days. The Kegels really help. In fact, I was encouraged to start Kegels prior to surgery. The simple direction was to always pee standing up and to interrupt the stream twice during each pee and hold for five seconds during each interruption. I still do that.”

Knowlege is power

As I wrote in my previous article about side effects, “I share this information for anyone who is contemplating surgery as treatment for prostate cancer. Talk to your team about the immediate impact of radical surgery. Be prepared.” Now there’s one more possible side effect to be aware of and discuss. Has anyone else in our community experienced this side effect? Please share if you have. We learn so much from each other.