Background: Rectal injury (RI) is a rare yet serious complication of radical prostatectomy (RP). In this study, we aimed to assess the incidence, risk factors, management strategies, and outcomes of RI during RP.Methods: A retrospective analysis was conducted on 382 patients who underwent RP between 2012 and 2024. Cases of RI were identified intraoperatively, and repair techniques, including two-layer rectal wall closure and vesicourethral anastomosis, were recorded. Risk factors, such as prior pelvic surgery and high-risk pathological features, were also analyzed. Postoperative continence status at 12 months was evaluated using daily pad count, and erectile dysfunction was evaluated using the International Index of Erectile Function (IIEF-5)Results: RI was observed in 2.4% of patients (n = 9), and repairs were successfully completed intraoperatively in all cases. During multivariate analysis, the BMI was found to be protective against RI. Among RI patients, one patient developed a rectourethral fistula, which required reoperation and diversion colostomy; however, six months after the closure colostomy, the fistula persisted, and the patient suffered from severe incontinence. The postoperative 12-month IIEF-5 median score was 7.Conclusions: This study highlights the importance of early intraoperative detection and meticulous surgical repair of RI during RP. Diagnostic measures, such as pneumatic testing and rectal wall monitoring, can mitigate postoperative complications. Our findings contribute to a better understanding of RI management and underscore the importance of individualized surgical approaches for high-risk patients.
背景：直肠损伤是根治性前列腺切除术中罕见但严重的并发症。本研究旨在评估根治性前列腺切除术中直肠损伤的发生率、危险因素、处理策略及预后。 方法：对2012年至2024年间接受根治性前列腺切除术的382例患者进行回顾性分析。术中识别直肠损伤病例，记录包括直肠壁双层缝合及膀胱尿道吻合术在内的修复技术。同时分析既往盆腔手术史及高危病理特征等危险因素。术后12个月通过每日尿垫使用量评估尿控状态，并采用国际勃起功能指数问卷评估勃起功能障碍情况。 结果：2.4%的患者（n=9）发生直肠损伤，所有病例均于术中成功完成修复。多变量分析显示体重指数对直肠损伤具有保护作用。直肠损伤患者中，1例发生直肠尿道瘘，需再次手术并行转流性结肠造口术；但造口闭合6个月后瘘管仍持续存在，患者出现严重尿失禁。术后12个月国际勃起功能指数问卷中位得分为7分。 结论：本研究强调根治性前列腺切除术中早期发现直肠损伤并进行精细手术修复的重要性。术中采用充气试验及直肠壁监测等诊断措施可减少术后并发症。本研究结果有助于深化对直肠损伤处理的认识，并强调对高危患者采取个体化手术方案的重要性。
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