Transient renal dysfunction due to rhabdomyolysis after robot-assisted radical prostatectomy
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UROLOGY - ORIGINAL PAPER
Transient renal dysfunction due to rhabdomyolysis after robot‑assisted radical prostatectomy Akifumi Onagi1 · Nobuhiro Haga2 · Ryo Tanji1 · Ruriko Honda1 · Kanako Matsuoka1 · Seiji Hoshi1 · Tomoyuki Koguchi1 · Jyunya Hata1 · Yuichi Sato1 · Hidenori Akaihata1 · Masao Kataoka1 · Soichiro Ogawa1 · Yoshiyuki Kojima1 Received: 17 March 2020 / Accepted: 7 May 2020 © Springer Nature B.V. 2020
Abstract Purpose The aim of the present study was to investigate whether renal dysfunction following rhabdomyolysis occurs after robot-assisted radical prostatectomy (RARP), and to investigate the factors related to rhabdomyolysis after RARP. Methods A total of 180 consecutive patients who underwent RARP at our institution were investigated. Rhabdomyolysis was defined as creatine kinase (CK) > 1050 IU/L after RARP. The association between CK and renal function after RARP was investigated, and the factors related to rhabdomyolysis after RARP were also investigated. Results Postoperative CK (407 ± 936 IU/L) was significantly higher than preoperative CK (134 ± 75 IU/L) (p 25.7 kg/m2) and longer console time (> 188 min) (p = 0.02 and p = 0.005, respectively). Conclusion Temporary renal dysfunction can occur after RARP due to CK elevation. Thus, sufficient attention must be paid to renal insufficiency after elevation of CK values for several days after RARP. Because rhabdomyolysis after RARP was associated with both obesity and long console time, console time during RARP should be shortened, especially in patients with obesity. Keywords RARP · Creatinine kinase · Rhabdomyolysis · Prostate cancer
Introduction Robot-assisted radical prostatectomy (RARP) via the transperitoneal approach, which has been accepted throughout the world, is performed in the high lithotomy position with a steep 25–30 degree head-down position [1, 2]. In this surgical position for RARP via the transperitoneal approach, excessive flexure of the knee can cause a local circulatory disturbance in the lower limb, damaging skeletal muscle and * Akifumi Onagi [email protected] 1
Department of Urology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima 960‑1295, Japan
Faculty of Medicine, Fukuoka University, Fukuoka, Japan
2
nerves [3]. It is considered that, in this surgical position, rhabdomyolysis can easily occur [4]. At the worst, so-called compartment syndrome can occur after surgery [4, 5]. Pridgeon et al. reported that compartment syndrome occurred after RARP in 0.29% of cases [6]. Skeletal muscle damage induces release of creatine kinase (CK) and myoglobin into the blood stream [7, 8]. These enzymes occlude the renal tubules, which can cause acute renal failure [7, 8]. This pathological condition is rhabdomyolysis [7, 8]. Although there are no definitive criteria for the diagnosis of rhabdomyolysis, development of acute renal failure occurs readily when CK values exceed 10005000 IU/L [9–12]. After the occurrence of rhabdomyolysis, 15–46% of patients developed acute renal failure, and 4.3% of the pa
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