A low RENAL Nephrometry Score Can Avoid the Need for the Intraoperative Insertion of a Ureteral Catheter in Robot-assisted Partial Nephrectomy

Abstract

BackgroundIntraoperative 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.MethodsOf 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.ResultsIntraoperative 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 (area under the curve [AUC]: 0.818, cut-off: 7, sensitivity: 0.80, specificity: 0.68) and RNS total score excluding the L-score (AUC: 0.848, cut-off: 5, sensitivity: 0.83, specificity: 0.73). ConclusionA ureteral catheter should not be placed in patients with an RNS total score ≤6 or RNS total score excluding the L-score of 3 or 4.