Cases of femoral nerve palsy after radical prostatectomy

Although postoperative femoral neuropathy is an uncommon complication occurring after pelvic surgery, we experienced several cases of femoral nerve palsy in patients after radical prostatectomy. All cases had neither previous vascular nor peripheral nerve disease. To investigate the possible etiology, we compared the difference in age, height, body weight, body mass index (BMI), duration of surgery, and volume of bleeding in patients with or without femoral nerve palsy. Although age and volume of bleeding were similar in groups, height, body weight, BMI, and duration of surgery in nerve palsy group (n = 5) were significantly larger than those without nerve palsy (n = 9). To evade these complications, inappropriate stretching and prolonged compression of the nerve during surgery, two major mechanisms of the neuropathy, were asked not to do to urological surgeons. In addition, intravenous patient-controlled analgesia (IV-PCA) was also used for postoperative analgesia instead of epidural analgesia. After these strategies, we found that the frequency of femoral nerve palsy had considerably decreased. Patients received physical therapy and showed nearly total neurological recovery. We report here unusual complication following major pelvic surgery, and discuss the possible etiology and some strategies for prevention of this injury.