The Use of a Surgical Patch in the Prevention of Lymphoceles After Extraperitoneal Pelvic Lymphadenectomy for Prostate Cancer: A Randomized Prospective Pilot Study Alchiede Simonato,* Virginia Varca, Marco Esposito, Fabio Venzano and Giorgio Carmignani From the Luciano Giuliani Institute of Urology, University of Genoa, Genoa, Italy Purpose: Pelvic lymphadenectomy is frequently performed simultaneously with radical prostatectomy to determine lymph node status and the most frequently recorded postoperative complication is the development of a symptomatic lym- phocele. This study evaluated TachoSil® as an adjunct treatment in preventing lymphoceles after extraperitoneal pelvic lymphadenectomy for prostate cancer. Materials and Methods: A total of 60 consecutive patients who had undergone radical prostatectomy and pelvic lymphadenectomy were prospectively enrolled in this study. The patients were randomly assigned to a standard technique with the use of clips and electrocoagulation plus TachoSil, or to standard technique only. All patients underwent ultrasound examination on postoperative days 7, 14 and 28 to test for the development of symptomatic or asymptomatic lymphoceles. Drainage volume and duration were also recorded. Results: The baseline characteristics of the 2 randomized groups were well matched. Those patients in whom we used TachoSil showed a lower drainage volume with a mean total volume of 64  45 ml (range 0 to 110) vs 190  62.72 ml (range 70 to 270, p  0.009), and had significantly fewer symptomatic and asymptomatic lymphoceles (5 vs 19, p  0.001). Only 5 percutaneous surgical procedures to drain the lymphoceles proved necessary, 1 of which occurred in the group with TachoSil. Conclusions: TachoSil seems to provide a useful additional treatment option for reducing drainage volume and preventing lymphocele development after extra- peritoneal radical retropubic prostatectomy with pelvic lymphadenectomy. Key Words: lymphocele, lymph node excision, prostatectomy, complications, pelvis Abbreviations and Acronyms DVT  deep venous thrombosis PLA  pelvic lymphadenectomy RRP  radical retropubic prostatectomy Submitted for publication March 5, 2009. * Correspondence: Department of Urology Lu- ciano Giuliani, University of Genoa, Genoa, Italy (e-mail: alchiede.simonato@unige.it). PELVIC lymphadenectomy is frequently performed simultaneously with radical prostatectomy to determine lymph node status. A surgical approach is ab- solutely necessary since to date no im- aging study equals PLA for sensitivity and specificity in the detection of lymph node metastasis. 1 However, this poten- tial benefit must be weighed against the additional morbidity and costs as- sociated with PLA. To make a proper assessment extensive knowledge of the complications of PLA is essential. In the literature the most frequently re- corded postoperative complication of lymph node dissection is the develop- ment of a symptomatic lymphocele. 2–5 Another important point is the avoid- ance of unnecessary lymphadenectomy in patients at low risk for lymph node involvement. This issue is still contro- versial, not least because of studies 0022-5347/09/1825-2285/0 Vol. 182, 2285-2290, November 2009 THE JOURNAL OF UROLOGY ® Printed in U.S.A. Copyright © 2009 by AMERICAN UROLOGICAL ASSOCIATION DOI:10.1016/j.juro.2009.07.033 www.jurology.com 2285