Can leakage at the vesico‐urethral anastomosis be predicted after radical retropubic prostatectomy?

Abstract

assess vesico-urethral integrity before catheter removal. RESULTSOf the 275 patients, 75% and 89% had cystography before 8 and 10 days after RRP, respectively; 71% of patients had no leak on cystography and were catheter-free at 8 days. Eighty-four leaks were identified, of which 25 (9.6%) were moderate or large. Previous transurethral prostatectomy, ischaemic heart disease, blood loss, mucosal eversion and preservation of the prostatic urethra were significant risk factors for developing a leak and were used to create a nomogram to assess the relative risk of leakage. However, none of the variables assessed, either alone or combined, could be used to predict which leaks were clinically significant. CONCLUSIONSLeakage cannot be reliably predicted at the vesico-urethral anastomosis. Cystograms are necessary to identify clinically significant leaks at 8 days and should be taken if early catheter removal is being considered.

What is the long‐term relevance of clinically detected postoperative anastomotic urine leakage after robotic‐assisted laparoscopic prostatectomy?

“…Although the present study did not aim to predict postoperative anastomotic urine leak, as other studies have attempted [5,12,13], there are several findings that are consistent with these previous studies. Among patients with anastomotic urine leak, an increased rate of bladder neck reconstruction was found.…”

“…This is consistent with studies showing that blood loss is a significant predictor of urinary extravasation on postoperative cystogram [12], as well as with studies suggesting the proposed mechanism of pooled blood in the pelvis exerting distraction forces on the vesico-urethral anastomosis causing partial separation and anastomotic leakage. Indeed, O'Malley et al [14] recently showed that transabdominal ultrasound measurement of pelvic haematoma volume predicted extravasation on cystography almost perfectly (area under the curve of receiver-oprator characteristic = 0.99).…”

“…Surya et al [19] suggested that prolonged urine leaks are a risk factor for anastomotic stricture. By contrast, other studies have reported no significant increase in anastomotic stricture even in patients with cystographic leaks detected for postoperative times beyond 18 days [12,17].…”

“…Despite these studies [5,12,13] attempting to predict the postoperative anastomotic urine leak, there are few studies documenting longterm morbidity among such patients [17]. No relationship was found between urine leak and long-term erectile function, as measured by SHIM scores.…”

Robotic urologic surgery complications

“…However, obesity and excessive bleeding were associated with decreased visibility of the bladder neck, hampering suture placement in urethro-vesical anastomosis [14] . As a surgical factor, non-eversion of the mucosa was suggested for tighter anastomosis instead of eversion [15] .…”