A low RENAL Nephrometry Score can avoid the need for the intraoperative insertion of a ureteral catheter in robot-assisted partial nephrectomy

Abstract

Background Intraoperative urinary collecting system entry (CSE) in robot-assisted partial nephrectomy (RAPN) may cause postoperative urinary leakage and extend the hospitalization. Therefore, identifying and firmly closing the entry sites are important for preventing postoperative urine leakage. In RAPN cases expected to require CSE, we insert a ureteral catheter and inject dye into the renal pelvis to identify the entry sites. We retrospectively analyzed the factors associated with intraoperative CSE in RAPN and explored the indications of intraoperative ureteral catheter indwelling in RAPN. Methods Of 104 Japanese patients who underwent RAPN at our institution from August 2016 to March 2020, 101 were analyzed. The patients were classified into CSE and non-CSE groups. The patients’ background characteristics, RENAL Nephrometry Score (RNS), and surgical outcomes were analyzed. Results Intraoperative CSE was observed in 41 patients (41%). The CSE group had a significantly longer operative time, console time, ischemic time, and hospital stay than the non-CSE group. In a multivariable analysis, the N-score (odds ratio [OR] = 3.9, P < 0.05) and RNS total score excluding the L-score (OR = 3.1, P < 0.05) were associated with CSE. In a logistic regression analysis, CSE showed a moderate correlation with the RNS total score excluding the L-score (AUC 0.848, cut-off 5, sensitivity 0.83, specificity 0.73). Conclusion A ureteral catheter should not be placed in patients with an RNS total score (excluding the L-score) of ≤ 4.

Factors influencing warm ischemia time in robot-assisted partial nephrectomy change depending on the surgeon’s experience

“…RALPN was performed using standard transperitoneal or retroperitoneal approaches depending on the patient’s history of trans-abdominal surgery, the tumor size, and the tumor location. We did not use a ureteral catheter [ 15 ]. Partial nephrectomy was performed by clamping the main trunk of a renal artery(s) with a bulldog clamp.…”

Need to clamp indwelling urinary catheters before removal after different durations: a systematic review and meta-analysis

“…Indwelling catheters are frequently used in clinical settings, with catheterisation rates ranging from 12% to 77% 1. They have been largely used to address chronic urinary retention and bladder obstruction, prevent intraoperative bladder dilation and incontinence and record urine volume 2 3. When indwelling urinary catheters are used, the bladder is constantly voiding with continuous urine drainage.…”

Impact of tumor contact surface area on collecting system entry in robot-assisted partial nephrectomy: a retrospective analysis

“…The N factor has been reported to be useful for evaluating the risk for collecting system entry (CSE), one of the potential complications of PN. [ 10 ] Therefore, ureteral catheter placement is considered for the prevention of postoperative urine leakage in cases with a high risk of CSE, such as those with an N score of 3. Nevertheless, we have experienced CSE in cases with low N factor scores of 1 or 2, and there was no clear information available regarding the risk factors for CSE.…”