Rectal Injury During Radical Prostatectomy: Incidence, Management, and Outcomes in Single-Center Experience

<b>Background</b>: 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. <b>Methods</b>: 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) <b>Results</b>: 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. <b>Conclusions</b>: 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.