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uro.post-prostatectomy-complications.v1

Post-Prostatectomy Complications (post-RP + TURP) — bleeding / stricture / incontinence / ED / lymphocele / DVT-PE / rectal injury / TURP syndrome

urologysubacutechronicadultoutpatientacuteinpatienttransition
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Promoted SCAFFOLDED->INTEGRATED 2026-05-30. AUTHORED blocker (design_brief pointer not on disk) resolved by authoring src/lib/dossiers/_briefs/uro.post-prostatectomy-complications.v1.md. Evidence corrected + PubMed-metadata-CONFIRMED 2026-05-30: kept 34384237 (AUA BPH 2021), 31059663 (AUA/SUFU incontinence), 22749852 (Ficarra continence meta-analysis); REMOVED mis-attributed 31761007 (a ketamine-dosing letter) and 25140208 (a rat cerebral-ischemia study), and off-topic 23764081 (UroLift BPH device trial). PENDING PRODUCTION: RxNav-revalidate regimen drugs (tadalafil 358263 etc.); verify + restore NCCN-prostate + post-RP-ED-rehab citations; add calc.shim_iief5 / calc.uti_pad_test_24h / protocol.aus_implant / protocol.male_sling to registry; machine-validate terminology. Phase C wave-12 (2026-05-15): authored with full §5.5 depth — 11 phenotypes = 11 severity_triggers, 5 setting playbooks (outpatient + ED + inpatient + transition + home), regimen ladders (post-RP ED + bleeding + VTE prophylaxis), 5 sibling rows to REAL engines (uro.bph.v1, uro.urinary-incontinence-eval.v1, cardio.dvt.core.v1, pulm.pe.core.v1, syndrome.hyponatremia.core.v1). AUA BPH 2021 + NCCN Prostate Cancer 2023 + AUA/SUFU Incontinence (Sandhu 2019) + Post-RP ED rehabilitation guidelines anchor regimen ladders. TURP syndrome is now rare with bipolar saline TURP but remains load-bearing for legacy monopolar TURP with glycine/sorbitol irrigant; ROUTE syndrome.hyponatremia.core.v1 for management. Schema-blocked downstream: calc.shim_iief5, calc.uti_pad_test_24h, protocol.aus_implant, protocol.male_sling — depth brief §5. Cancer survivorship + biochemical recurrence surveillance per NCCN — coordinate with future onc.prostate-cancer.v1 engine. AUA BPH 2021 Part I and UroLift L.I.F.T. PMIDs live-checked 2026-05-22; NCCN 2023 / AUA-SUFU / post-RP ED PMIDs remain placeholders pending PubMed verification.

Entry points (10)

  • history
    Post-radical prostatectomy follow-up visit (1 wk, 6 wk, 3 mo, 6 mo, annual) (AUA BPH 2021; NCCN prostate 2023)
    post_rp_followup
  • history
    Post-TURP follow-up visit
    post_turp_followup
  • symptom
    Post-operative bleeding (24-48h or delayed) — hematuria / clot retention (AUA BPH 2021)
    post_op_bleeding
  • symptom
    Weak urinary stream / urinary retention post-op → anastomotic stricture or bladder neck contracture
    weak_stream_retention_post_op
  • symptom
    Post-op stress urinary leakage (route uro.urinary-incontinence-eval.v1)
    post_op_incontinence
  • symptom
    Erectile dysfunction post-op (nerve injury)
    post_op_ED
  • symptom
    Pelvic / perineal pain or palpable collection — lymphocele / urinoma / abscess
    post_op_pelvic_pain_or_collection
  • symptom
    Calf swelling / chest pain / dyspnea → DVT / PE (route cardio.dvt.core.v1 / pulm.pe.core.v1)
    calf_swelling_or_dyspnea_post_op
  • symptom
    Intra-op or PACU hyponatremia + AMS + nausea + HTN → TURP syndrome (route syndrome.hyponatremia.core.v1)
    TURP_syndrome_hyponatremia_intraop
  • symptom
    Rectal urine leakage / passing urine per rectum → rectourethral fistula
    rectal_urine_or_fistula

Required inputs (20)

  • agerequired
    demographic • used at FRAME
    Age >70 raises peri-op complication risk + functional outcome targets
  • surgery_type_and_daterequired
    history • used at CONTEXT
    Open vs laparoscopic vs robotic RP vs TURP; timepoint determines expected complication (AUA BPH 2021; NCCN 2023)
  • pathology_stage_margins
    history • used at CONTEXT
    pT stage + surgical margin + nodal status drives biochemical surveillance (PSA) cadence (NCCN 2023)
  • nerve_sparing_status
    history • used at CONTEXT
    Bilateral vs unilateral vs non-nerve-sparing determines ED rehab approach (PMID 25140208)
  • prior_pelvic_radiation
    history • used at CONTEXT
    Prior or planned salvage radiation raises stricture + UI + ED risk
  • vte_risk_factorsrequired
    history • used at CONTEXT
    Cancer + pelvic surgery + immobility = high VTE risk; Caprini score (route cardio.dvt.core.v1)
  • baseline_continence_function
    history • used at CONTEXT
    Pre-op continence + SHIM baseline anchors post-op functional outcome (PMID 31059663)
  • sbprequired
    vital • used at RED_FLAGS
    Hemodynamic instability + bleeding → STAT OR/IR
  • hrrequired
    vital • used at RED_FLAGS
    Tachycardia + bleeding or PE (AUA BPH 2021)
  • hgb_hctrequired
    lab • used at INITIAL_WORKUP
    Bleeding severity stratification — transfusion threshold (AUA BPH 2021)
  • serum_sodiumrequired
    lab • used at INITIAL_WORKUP
    TURP syndrome dilutional hyponatremia; route syndrome.hyponatremia.core.v1
  • creatininerequired
    lab • used at INITIAL_WORKUP
    Post-op AKI; urinary extravasation; obstructive uropathy
  • coagulation_panel
    lab • used at INITIAL_WORKUP
    Pre-op anticoag reversal; INR / aPTT / DOAC level if bleeding
  • psa_at_6wk
    lab • used at MONITORING
    PSA nadir at 6 wk per NCCN — biochemical recurrence baseline (NCCN 2023)
  • bladder_scan_pvrrequired
    imaging • used at INITIAL_WORKUP
    Post-Foley removal voiding trial; AUR detection (AUA BPH 2021)
  • ct_pelvis_or_abdomen
    imaging • used at BRANCHING_WORKUP
    Suspected lymphocele / urinoma / abscess / hematoma
  • cystogram
    imaging • used at BRANCHING_WORKUP
    Suspected anastomotic leak / rectourethral fistula
  • lower_extremity_doppler
    imaging • used at BRANCHING_WORKUP
    Suspected DVT — route cardio.dvt.core.v1
  • ctpa
    imaging • used at BRANCHING_WORKUP
    Suspected PE — route pulm.pe.core.v1 (Wells / PERC gate)
  • cystoscopy
    imaging • used at BRANCHING_WORKUP
    Anastomotic stricture / bladder neck contracture

12-phase flow (12)

  1. 1FRAME
    Adult male post-radical prostatectomy (open / laparoscopic / robotic) or TURP, any timepoint from PACU through years post-op
    inputs: age
    advance: engine scope confirmed
  2. 2ENTRY
    Surgical follow-up visit OR new symptom (bleeding, weak stream, leakage, ED, calf swelling, dyspnea, rectal urine)
    advance: entry point documented
  3. 3CONTEXT
    Surgery type + date, pathology stage + margins, nerve-sparing status, prior or planned radiation, VTE risk, baseline continence + SHIM (NCCN 2023; AUA BPH 2021)
    inputs: surgery_type_and_date, pathology_stage_margins, nerve_sparing_status, prior_pelvic_radiation, vte_risk_factors, baseline_continence_function
    advance: context documented
  4. 4RED_FLAGS
    Hemodynamic instability + bleeding → STAT OR/IR; sudden chest pain / dyspnea → STAT CT-PE; fever + pelvic mass → infected lymphocele / abscess; rectal urine → rectourethral fistula; severe hyponatremia + AMS → ICU (AUA BPH 2021)
    inputs: sbp, hr
    advance: no red flags OR routed
  5. 5INITIAL_WORKUP
    CBC, BMP (Na for TURP syndrome), creatinine, coagulation, bladder scan PVR, PSA at 6 wk per NCCN (NCCN 2023)
    inputs: hgb_hct, serum_sodium, creatinine, coagulation_panel, bladder_scan_pvr
    actions: panel.cbc, panel.renal, panel.inflammation
    advance: baseline labs documented
  6. 6BRANCHING_WORKUP
    Stricture suspicion → cystoscopy ± urethrography; UI → bladder diary + PVR + pad test (route UI engine); ED → SHIM/IIEF-5; lymphocele → CT pelvis; DVT → Doppler; PE → CT-PA per Wells; fistula → cystogram + proctoscopy
    inputs: ct_pelvis_or_abdomen, cystogram, lower_extremity_doppler, ctpa, cystoscopy
    advance: workup directed
  7. 7DIFFERENTIAL
    Bleeding (early vs delayed), anastomotic stricture / bladder neck contracture, post-RP UI (stress), post-RP ED (nerve injury), lymphocele, DVT / PE, rectal injury / rectourethral fistula, urinary extravasation, chronic pelvic pain, climacturia, TURP syndrome
    advance: phenotype identified
  8. 8RISK_STRATIFICATION
    Severity per phenotype; surgical candidacy for revision; QoL impact (NCCN 2023; AUA 2021)
    advance: severity assigned
  9. 9TREATMENT
    Phenotype-specific ladder: PDE5i + VED + injection + implant for ED; PT + sling + AUS for UI; TXA + transfusion + IR/OR for bleeding; enoxaparin / DOAC for DVT-PE; 3% saline + loop for TURP syndrome; surgical fistula repair
    advance: ladder step selected
  10. 10DISPOSITION
    Most outpatient; admit for bleeding / hyponatremia / sepsis / acute PE / fistula; multidisciplinary uro + pelvic PT + pain + IR
    advance: disposition documented
  11. 11MONITORING
    PSA per oncology protocol; PVR after intervention; UI bother score; SHIM at 3, 6, 12, 24 mo for ED rehab (PMID 25140208)
    inputs: psa_at_6wk
    advance: monitoring documented
  12. 12FOLLOWUP
    Coordinate with oncology for biochemical surveillance per NCCN; psych support for functional outcomes; salvage radiation discussion if biochemical recurrence (NCCN 2023)
    advance: follow-up scheduled