Intraoperative and early postoperative complications of radical retropubic prostatectomy.

INTRODUCTION: To determine the perioperative complications and morbidity of radical retropubic prostatectomy (RRP) and to analyze risk factors for observed complications. MATERIALS AND METHODS: Data of 1,000 patients undergoing RRP and pelvic lymphadenectomy (pLA) performed by different surgeons of the same hospital were collected. Uni- and multivariate analysis was performed to detect associations between intra- and postoperative complications and specific variables. RESULTS: Relevant intraoperative complications were observed in 28 cases and relevant postoperative complications in 187 cases requiring reoperations in 46 patients. Diverse minor postoperative complications occurred in 75 cases. The surgeon's experience and the operating time significantly influenced the incidence of intraoperative complications. Extended pLA was associated with significantly higher rates of lymphoceles and reoperations. The patients with lymphocele showed significantly higher rates of deep venous thrombosis (DVT), pulmonary embolism (PE) and reoperation and patients with DVT a higher incidence of PE and a higher rate of reoperations. The incidence of anastomotic strictures correlated significantly with postoperative urine retention. CONCLUSIONS: RRP is a safe surgical procedure. In the hands of experienced urologic surgeons it is associated with lower incidences of severe intraoperative complications. A substantial proportion of postoperative complications are associated with pLA and its extension.

Is sudden unexplained death in adult epileptic patients associated with geomagnetic disturbances at the day of death or the 4 days before?

Geomagnetic disturbances are controversially discussed as risk factor for sudden unexplained death in epilepsy (SUDEP). An autopsy-based cohort of 39 adult patients with definite SUDEP were compared to 102 epileptic patients with known cause of death (KCD), who died between 1981 and 1992. Most of them had suffered from therapy-resistant epilepsies, predominantly characterized by generalized tonic-clonic seizures (about 70%). We analyzed an international geomagnetic index, the mean planetary daily amplitude (Ap), and the appearance of storm sudden commencement (SSC) at the individual day of decease and the 4 days before (and after). The SUDEP and KCD patients did not substantially differ with respect to the Ap values (Mann-Whitney test; P>0.2) and frequency of SSC (Fisher test; P>0.2) at death or the 4 premortem days. In addition, Ap values above 50 nanoTesla, postulated as critical threshold by other authors, showed no significant difference between SUDEP and KCD group for the day of death (5.1 versus 3.9%) or the 4 days before (5.1 versus 11.8%) (Fisher test; P>0.2). Consequently, the current data did not support the hypothesis that geomagnetic activities may act as a relevant risk factor for SUDEP.