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

Abstract

ObjectiveTo evaluate the incidence of and risk factors for a urine leak in a large multicentre, prospective database of robot-assisted partial nephrectomy (RPN). Patients and MethodsA database of 1 791 RPN from five USA centres was reviewed for urine leak as a complication of RPN. Patient and tumour characteristics were compared between patients with and those without postoperative urine leaks. Fisher's exact test was used for qualitative variables and Wilcoxon sum-rank tests were used for quantitative variables. A review of the literature on PN and urine leak was conducted. ResultsUrine leak was noted in 14/1 791 (0.78%) patients who underwent RPN. The mean (SD) nephrometry score of the entire cohort was 7.2 (1.9), and 8.0 (1.9) in patients who developed urine leak. The median (range) postoperative day of presentation was 13 (3-32) days. Patients with urine leak presented in delayed fashion with fever (two of the 14 patients, 14%), gastrointestinal complaints (four patients, 29%), and pain (five patients, 36%). Eight of the 14 patients (57%) required admission, while eight (57%) and nine (64%) had a drain or stent placed, respectively. Drains and stents were removed after a median (range) of 8 (4-13) days and 21 (8-83) days, respectively. Variables associated with urine leak included tumour size (P = 0.021), hilar location (P = 0.025), operative time (P = 0.006), warm ischaemia time (P = 0.005), and pelvicalyceal repair (P = 0.018). Upon literature review, the historical incidence of urine leak ranged from 1.0% to 17.4% for open PN and 1.6-16.5% for laparoscopic PN. ConclusionThe incidence of urine leak after RPN is very low and may be predicted by some preoperative factors, affording better patient counselling of risks. The low urinary leak rate may be attributed to the enhanced visualisation and suturing technique that accompanies the robotic approach.

Predictive Value of Nephrometry Scores in Nephron-sparing Surgery: A Systematic Review and Meta-analysis

“…In fact, higher nephrometry scores and complexity were related to pelvicalyceal system entry/repair. Potretzke et al [77] conducted a review of studies on urinary fistula after robotic PN, and found that pelvicalyceal system entry and tumor size were related to the development of urine leak. These two parameters could be interpreted as a reflection of tumor complexity, which could be the reason for urinary fistula incidence.…”

Comparison of perioperative outcomes with or without renorrhaphy during open partial nephrectomy: A propensity score-matched analysis

“…The incidence of urine leakage in OPN is reported to range from 1.0 to 17.4%; this incidence is higher than that in minimally invasive partial nephrectomy because of the indication for relatively hilar-located tumors in OPN ( 24 ). Urine leakage occurs if the collecting system opens during the resection of hilar tumors and is not fully repaired.…”

Algorithm for Bosniak 2F Cyst in Kidney Donation

“…Other risk factors for hemorrhagic complications are high American Society of Anesthesiologists (ASA) scores and smoking [25]. 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].…”

“…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]. …”