Differential Diagnosis for Nerve Injury Following Robotic Prostatectomy
Single Most Likely Diagnosis
- Femoral nerve (B): The femoral nerve is at risk during pelvic surgeries like robotic prostatectomy due to its proximity to the surgical field. Injury to this nerve could explain the decreased sensation along the anteromedial thigh and lower extremity weakness, as the femoral nerve supplies the anterior thigh muscles and provides sensory innervation to the anteromedial thigh.
Other Likely Diagnoses
- Obturator nerve (A): The obturator nerve could be injured during pelvic surgeries, leading to weakness in the adductor muscles of the thigh. However, the sensory symptoms described are less typical for an isolated obturator nerve injury.
- Lateral femoral cutaneous nerve (C): While injury to this nerve could result in sensory changes, it typically causes numbness or paresthesia over the lateral aspect of the thigh, not the anteromedial thigh. It's less likely to cause significant lower extremity weakness.
Do Not Miss Diagnoses
- Sciatic nerve (D): Although less likely due to its deeper location, sciatic nerve injury is a critical diagnosis not to miss, as it can result in significant morbidity, including weakness and sensory loss in much of the lower extremity. The symptoms described don't perfectly align with a sciatic nerve injury, but given the potential impact, it's essential to consider.
- Genitofemoral nerve (E): Injury to the genitofemoral nerve might occur during pelvic surgery, but it's less likely to cause the specific combination of symptoms described, as it primarily provides sensory innervation to the genitalia and a small area of the anterior thigh.
Rare Diagnoses
- Combined nerve injuries: The possibility of injury to multiple nerves (e.g., femoral and obturator) should be considered, especially if the symptoms are complex or do not fit neatly with a single nerve injury pattern.
- Nerve root or plexus injuries: Although rare, injuries at the level of the nerve roots or lumbosacral plexus could potentially occur during surgery, leading to a wide range of lower extremity symptoms. These would be unusual complications of robotic prostatectomy but are important to recognize due to their significant impact on function and recovery.