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.

In which cases does collecting system entry occur in robot-assisted partial nephrectomy? Development of a novel predictive model based on the contact surface area of the tumor to the renal parenchyma

“…14,15 The N factor of the RNS represents the tumor's proximity to the collecting system or sinus, and high scores for the N factor have been correlated with the occurrence of CSE. 10 An N factor score of 3 represents a distance less than 4 mm, which indicates a high probability of CSE. Consistent with this nding, the incidence of positive CSE in cases with an N score of 3 in our cohort was 71%…”

“…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.…”