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

Abstract

predicting urinary extravasation were ascertained and compared with that of postoperative blood loss, measured as the difference between the haematocrit immediately after RRP and that at discharge. RESULTSThe sensitivity and specificity of PHV for predicting urinary extravasation at a threshold of 37 mL was 100% and 96%, respectively. PHV was superior to postoperative blood loss in predicting anastomotic extravasation, as shown by an area under the receiver operating curve of 0.99 vs 0.91, respectively. CONCLUSIONSOur findings provide compelling evidence that delayed healing of the anastomosis after RRP is due to distraction forces secondary to a pelvic haematoma. The accuracy of PHV as a predictor of anastomotic extravasation suggests that this measurement might replace cystography for assessing anastomotic integrity after RRP. KEYWORDSprostate cancer, surgical anastomosis, prostatectomy, extravasation, postoperative blood loss Study Type -Therapy (case series) Level of Evidence 4 OBJECTIVETo determine the mechanism for delayed healing of the urinary anastomosis after radical retropubic prostatectomy (RRP). PATIENTS AND METHODSThe volumes of the para-anastomotic haematoma (PHV) and anastomotic extravasation were measured by ultrasonography in 95 men after RRP. The performance characteristics of PHV for

Side-fenestrated catheter decreases leakage at the urethrovesical anastomosis after robot-assisted laparoscopic radical prostatectomy

“…Postoperative bleeding and the resulting paraanastomotic haematoma have been suggested to be predictive factors for anastomotic leakage [26]. It is speculated that para-anastomotic haematoma may damage the anastomosis [26], which may be visually detected as blood-coloured urine during catheterization [27].…”

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

“…Over 50% of men feel a moderate or severe impairment of physical activity due to the indwelling catheter [7] and patients are described as having "four times the rate of moderate to severe bother from the catheter than from postoperative pain" [16].…”

“…O'Malley et al [16] investigated the volume of perianastomotic haematoma (PHV) as an indicator for the presence of anastomotic extravasation after RRP. They found a sensitivity and specificity of PHV for predicting urinary extravasation of 100% and 96%, respectively, but only for a threshold of 37 ml as measured by ultrasound.…”

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

“…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).…”