Incidence of Rectal Injury After Radical Prostatectomy: A Systematic Review and Meta-analysis

Rectal injury is a rare, but potentially devastating, complication following radical prostatectomy. Its incidence is higher in patients ≥60 yr of age, and in those undergoing open/laparoscopic versus robotic prostatectomy or salvage prostatectomy after radiation therapy. Intraoperative detection and repair constitute the most critical step to decrease the risk of severe postoperative complications including rectourethral fistula. Rectal injury (RI) is a dreaded complication after radical prostatectomy (RP), increasing the risk of early postoperative complications, such as bleeding and severe infection/sepsis, and late sequelae, such as a rectourethral fistula (RUF). Considering its traditionally low incidence, uncertainty remains as to predisposing risk factors and management. To examine the incidence of RI after RP in contemporary series and to propose a pragmatic algorithm for its management. A systematic literature search was performed using the Medline and Scopus databases. Studies reporting data on RI incidence were selected. Subgroup analyses were conducted to assess the differential incidence by age, surgical approach, salvage RP after radiation therapy, and previous benign prostatic hyperplasia (BPH)-related surgery. Eighty-eight, mostly retrospective noncomparative, studies were selected. The meta-analysis obtained a pooled RI incidence of 0.58% (95% confidence interval [CI] 0.46–0.73) in contemporary series with significant across-study heterogeneity (I2 = 100%, p