Postoperative Blood Loss Predicts the Development of Urinary Extravasation on Cystogram Following Radical Retropubic Prostatectomy

Abstract

The extent of postoperative bleeding predicts the extent of urinary extravasation on initial cystography. It may be a useful measurement for identifying men who can safely undergo early catheter removal without cystography.

Para‐anastomotic haematoma volume predicts the presence of anastomotic extravasation after radical retropubic prostatectomy

“…Predictors of anastomotic extravasation have been difficult to identify. Investigators failed to show that pelvic drain output volume, pelvic drain fluid creatinine level, body mass index, surgical specimen weight, number of anastomotic sutures, or the presence of intraoperative extravasation were significant predictors of postoperative anastomotic extravasation, thereby prompting recommendations for taking a cystogram in all candidates deemed suitable for early catheter removal [1,8,9]. Chodak et al.…”

Urine colour after radical prostatectomy predicts urinary leakage at the vesicourethral anastomosis

“…Other authors investigated factors such as postoperative haemoglobin or haematocrit level or intraoperative and postoperative bleeding as predictors for an anastomotic extravasation. A direct correlation between postoperative haemoglobin loss and the size of a urinary extravasation was found by Fening et al [25] in a series of 826 patients investigated after RRP. They hypothesized that a haematoma caused by postoperative bleeding (decrease of more than 6.2 haematocrit points) causes distraction of the anastomotic region and is thereby responsible for extravasation [25].…”

“…A direct correlation between postoperative haemoglobin loss and the size of a urinary extravasation was found by Fening et al [25] in a series of 826 patients investigated after RRP. They hypothesized that a haematoma caused by postoperative bleeding (decrease of more than 6.2 haematocrit points) causes distraction of the anastomotic region and is thereby responsible for extravasation [25]. There seems to be a relation between extravasation and blood loss, but the mechanism is still not properly understood.…”

The impact of urinary drainage on the development of anastomotic stricture after radical retropubic prostatectomy

“…Factors predisposing to extravasation at the vesicourethral anastomosis within the first week following RRP are poorly understood. According to recent studies, either watertight anastomosis or extent of bladder-neck reconstruction were unrelated to urinary leakage [10,11]. Fenig et al [11] demonstrated that even moderate or marked leakage was not associated with increased risk of AS or incontinence provided that the catheter was left indwelling until the resolution of urinary drainage.…”

“…According to recent studies, either watertight anastomosis or extent of bladder-neck reconstruction were unrelated to urinary leakage [10,11]. Fenig et al [11] demonstrated that even moderate or marked leakage was not associated with increased risk of AS or incontinence provided that the catheter was left indwelling until the resolution of urinary drainage. The magnification of laparoscopic technology provides surgeons with a more precise anatomic dissection of the prostate from surrounding tissue and watertight anastomotic suturing.…”