Delayed bilateral obturator nerve injury due to compressing bilateral pelvic lymphoceles after robot-assisted laparoscopic radical prostatectomy and bilateral lymphadenectomy for prostatic carcinoma

Abstract

A clinically significant obturator nerve injury is uncommon after robot-assisted radical prostatectomy and lymphadenectomy. If the injury is due to a direct intraoperative event such as transection or stretching of the nerve, the patients present typically in the immediate postoperative period. On the other hand, an indirect injury through compression of the nerve through a pelvic fluid collection (hematoma or lymphocele) progresses insidiously and delays the presentation of these patients making a dilemma in recognizing these patients and differentiating them from those with other causes of neurological deficits. A delay in the correct management of the compressing collections may negatively affect the neurological function of the patient. We demonstrate a 61-year-old male who presented with pain and motor weakness of obturator origin 1 week after robot-assisted radical prostatectomy and lymphadenectomy for prostatic cancer. The computed tomography scan showed bilateral pelvic lymphoceles possibly compressing the obturator nerves. The neurological function has improved after evacuation of these collections. This case emphasizes the importance of considering delayed postsurgical compression of the obturator nerve in our differential diagnosis when patients present with typical signs and symptoms of obturator nerve injury after robot-assisted radical prostatectomy and lymphadenectomy. Early diagnosis and evacuation of these collections would improve the neurological outcome.