Prognostic Factors for Anastomotic Urinary Leakage Following Retropubic Radical Prostatectomy and Correlation With Voiding Outcomes

Abstract

This study aimed to determine the occurrence and grade of cystographically detected urinary leakage (UL) in a contemporary series of open retropubic radical prostatectomy (RP), whether patients’ clinical variables predict occurrence of UL, and whether occurrence of UL correlates with patients’ voiding outcomes in terms of urinary continence and anastomotic stricture (AS).Enrolled patients underwent cystography 7 days after retropubic RP; in case of UL, the catheter was left in situ and cystography repeated at 7 days intervals until demonstrating absence of UL. Leakage was classified as grade I = extraperitoneal leak <6 cm, grade II = extraperitoneal leak >6 cm, grade III = leak freely extending in the small pelvis. Voiding was evaluated at 3, 6, and 12 months after RP using the 24-hour pad test and uroflowmetry; in cases of maximum flow rate <10 mL/s, urethrocystoscopy was carried out to determine presence and location of an AS.The first postoperative cystogram showed UL in 52.6% of patients (grade I in 48.1%, grade II in 21.5%, and grade III in 30.4% of the cases). Multivariate analysis demonstrated that patients with UL had significantly greater prostate volume (64.5 vs 34.8 cc, P < 0.001), loss of serum hemoglobin (4.77 vs 4.19 g/dL, P < 0.001), lower postoperative serum total proteins (4.85 vs 5.4 g/dL, P < 0.001), and higher rate of AS (20.6% vs. 2.8%, p < 0.001) than those without UL. Continence rate at 3, 6, and 12 months postoperatively was 34.2%, 76%, and 90%, respectively, in patients with UL compared with 77.5%, 80.3%, and 93% in patients without UL; such difference was statistically significant (P < 0.001) only at 3 months follow-up. ROC curve analysis showed that prostate volume and postoperative serum total proteins had the best AUC (0.821 and 0.822, respectively) and when combined, their positive and negative predictive values for UL were 90% and 93%, respectively.In conclusion, half of the patients undergoing open retropubic RP may present, 7 days postoperatively, some degree of cystographically detected UL; prostate volume, loss of serum hemoglobin, and postoperative serum total proteins could be used to predict it. UL delayed return to urinary continence without affecting long-term results, but led to a significantly higher rate of AS.

Use of Disposable Punch Biopsy Device to Add Foley Catheter Fenestration to Improve Drainage of Post Radical Prostatectomy Anastomotic Leak

“…AL complications are much more common in open prostatectomy, with one series from 2011-2013 showing a >50% leak rate at postoperative Day 7 on cystogram. 17 Several key findings of our experiment were evident. First, it is important to use the proper size Foley catheter (18 Fr) and proper size punch biopsy (3.0 mm).…”

Association between cystographic anastomotic urinary leakage following retropubic radical prostatectomy and early urinary incontinence

“…PPUI is a major complication of RRP and has a substantial impact on patient's quality of life because it affects physical activity and social well-being. The reported incidence of PPUI varies from 4% to 69% [9,10], depending on multiple factors such as age, preoperative voiding status, sphincteric functional competence, perioperative bladder function, and operative factors [10][11][12][13].…”

“…In cases of mild UL, the catheter was removed after 3 days, and for moderate UL, it was removed after 7 days [ 9 ]. In cases of severe UL, cystography was repeated at 7-day intervals with the catheter in situ until the UL ceased.…”

How to Prevent and Manage Post-Prostatectomy Incontinence: A Review

“…A number of studies [ 78 79 80 81 ] have associated a longer duration of postoperative catheterization with worst UC outcomes, with this conclusion resulting from nonrandomized, potentially biased studies. Hence no definitive conclusions can be drawn regarding this issue.…”