Does mechanical bowel preparation ameliorate damage from rectal injury in radical prostatectomy? Analysis of 151 rectal injury cases

作者：Sugihara Toru^*; Yasunaga Hideo; Horiguchi Hiromasa; Matsuda Shinya; Fushimi Kiyohide; Kattan Michael W; Homma Yukio

来源：International Journal of Urology, 2014, 21(6): 566-570.

DOI：10.1111/iju.12368

• complications
• mechanical bowel preparation
• outcome
• prostatectomy

Objective To evaluate whether mechanical bowel preparation before radical prostatectomy ameliorates damage from rectal injury in radical prostatectomy. Methods Among 35099 radical prostatectomy cases in the Japanese Diagnosis Procedure Combination database 2007-2012, those where a rectal injury occurred were stratified into a preoperative mechanical bowel preparation group (polyethylene glycol electrolyte, magnesium citrate solution and sodium picosulfate) and a non-mechanical bowel preparation group. The associations between mechanical bowel preparation and rectal injury were evaluated by multivariate regression analysis for: (i) subsequent infectious complications; (ii) requirement of delayed colostomy formation after primary closure; (iii) postoperative length of stay; and (iv) total costs. Covariates were age, surgical approach, Charlson Comorbidity Index, T and N category, hospital volume, hospital academic status, and colostomy formation. Results Overall, 151 rectal injury cases (0.43%) were identified. Of those, 73 patients (48%) received mechanical bowel preparation. Multivariate analyses showed that all four outcomes were not statistically different between mechanical bowel preparation and non-mechanical bowel preparation groups (infectious complication rate: 12% vs 10%, P=0.80; delayed colostomy rate: 21% vs 31%, P=0.34; length of stay: 28 vs 30 days, P=0.84; and total costs: $24665 vs $23837, P=0.81). Conclusion Our analysis did not detect a beneficial impact of mechanical bowel preparation on perioperative morbidity associated with rectal injury during radical prostatectomy. This finding suggests that mechanical bowel preparation might be safely omitted before radical prostatectomy.

• 出版日期2014-6