A 68-year-old male patient with a body mass index (BMI) of 31.2 was diagnosed with prostate cancer at stage T2a (PSA), stage T2a (BMI 3,18 ng specific).
She had a previous history of hypertension, diabetes, hyperlipemia, cardiomyopathy and cirrhosis.
Before the surgery, the patient had tapering and intermittent compression devices on both lower extremities to prevent deep vein thrombosis (DVT).
After administering combined general-spinal anesthesia, the patient was placed in the Trendelenburg position and underwent extraperitoneal LPR with bilateral nerve preservation.
His blood pressure at the time of anesthesia was 150 mmHg and remained below this level throughout the procedure.
The operation lasted 360 min and blood loss was 1,000 ml.
Bleeding occurred during vascular bundle control and dissection.
Surgical pathology revealed a prostate of 55 g, with adenocarcinoma stage T2a and a Gleason score 6 with negative margins.
On the first postoperative day, the patient complained of numbness and pain in the right side, which was inflamed and soft to the touch.
Pedicle pulses were present bilaterally.
We performed DVT and requested a Doppler test, which showed patency of the deep venous system.
Serum creatinine was 3.2 mg/dl and creatine phosphokinase reached 23,000 U/l.
Although the Doppler was normal, a DVT with secondary rabiesolysis and renal failure was diagnosed based on the clinical results, and treatment with heparin was started.
In the following days, although the pedal pulses were still palpable and serum creatinine and creatine phosphokinase levels improved, the patient had a worsening of episodes of intermittent pain.
Doppler tests were repeated, excluding DVT and showing a pattern of high resistance of the right tibial arteries.
The patient underwent a four-compartment fasciotomy due to the tapering CS.
Muscles emerged easily as the overlying fascia was dissected.
There were areas of focal necrosis that were eliminated.
Postoperatively, the patient was relieved and able to manage pain with help.
The wounds were closed 14 days after fasciotomy.
Six months after PRL, the patient became conscious and able to contract without help, but still presents neuropatic pain in the right foot.
His PSA was below 0.04 ng/ml, he used diapers for mild stress incontinence and had not yet recovered sexual function.
