Urine leak in minimally invasive partial nephrectomy: analysis of risk factors and role of intraoperative ureteral catheterization

Abstract

ARTICLE INFO ______________________________________________________________ ______________________Purpose: To investigate risk factors for urine leak in patients undergoing minimally invasive partial nephrectomy (MIPN) and to determine the role of intraoperative ureteral catheterization in preventing this postoperative complication. Materials and Methods: MIPN procedures done from September 1999 to July 2012 at our Center were reviewed from our IRB-approved database. Patient and tumor characteristics, operative techniques and outcomes were analyzed. Patients with evidence of urine leak were identified. Outcomes were compared between patients with preoperative ureteral catheterization (C-group) and those without (NC-group). Univariable and multivariable analyses were performed to identify factors predicting postoperative urine leak.Results: A total of 1,019 cases were included (452 robotic partial nephrectomy cases and 567 laparoscopic partial nephrectomy cases). Five hundred twenty eight patients (51.8%) were in the C-group, whereas 491 of them (48.2%) in the NC-group. Urine leak occurred in 31(3%) cases, 4.6% in the C-group and 1.4% in the NC-group (p<0.001). Tumors in NC-group had significantly higher RENAL score, shorter operative and warm ischemic times. On multivariable analysis, tumor proximity to collecting system (OR=9.2; p<0.01), surgeon's early operative experience (OR=7.8; p<0.01) and preoperative moderate to severe CKD (OR=3.1; p<0.01) significantly increased the odds of the occurrence of a postoperative urine leak. Conclusion: Clinically significant urine leak after MIPN in a high volume institution setting is uncommon. This event is more likely to occur in cases of renal masses that are close to the collecting system, in patients with preoperative CKD and when operating surgeon is still in the learning curve for the procedure. Our findings suggest that routine intraoperative ureteral catheterization during MIPN does not reduce the probability of postoperative urine leak. In addition, it adds to the overall operative time.

Urinary fistula after robot‐assisted partial nephrectomy: a multicentre analysis of 1 791 patients

“…In all, 21 OPN and 17 LPN articles were reviewed (Table ). The reported urinary leak rates ranged from 1.0% to 17.4% for OPN and 1.6–16.5% for LPN.…”

“… reported an OPN urinary leak rate of 1.1%, while Zargar et al. reported an overall urinary leak rate of minimally invasive PN (LPN and RPN) of 3% (31/1 019). Zargar and the group from Cleveland Clinic also note that a surgeon's early operative experience predicts urine leak; therefore it is reasonable to surmise that the evolving urinary leak rate is lower than reported.…”

Algorithm for Bosniak 2F Cyst in Kidney Donation

“…The incidence of urinary fistula after partial nephrectomy has ranged from 1% to 17.4% [26]. However, more recent studies report urinary leakage rates between 0.6% and 3% [27,28]. Risk factors include hilar tumor location, tumor size, blood loss, and need for pelvicalyceal repair [26,29–31].…”

Robotic-assisted partial nephrectomy without using ureteral stent: a single center experience

“…None of our patients had intraoperative problems or postoperative urine extravasations associated with refraining from catheterization. Zargar et al [22] reported that routine ureteral catheterization is not necessary in minimally invasive PN (LPN and RAPN) but it is necessary in cases where the mass is close to the collecting system or when novice surgeons are performing the procedure. They reported that routine ureteral catheterization did not provide any benefits in blocking urine extravasation.…”

“…They reported that routine ureteral catheterization did not provide any benefits in blocking urine extravasation. [22] Tomaszewski et al [23] also concluded that renal pelvic anatomy which is measured by renal pelvic score can also predict urine extravasation after open and robotic partial nephrectomy. Based on the renal pelvic scoring system, preoperative identification of the patients with increased risk for urine leak should be considered in perioperative management.…”