Urinary fistulae after partial nephrectomy Journal Article
| Authors: | Kundu, S. D.; Thompson, R. H.; Kallingal, G. J.; Cambareri, G.; Russo, P. |
| Article Title: | Urinary fistulae after partial nephrectomy |
| Abstract: | OBJECTIVE To report the risk factors and natural history of urinary fistula (UF) after partial nephrectomy (PN), as their incidence has been reported to be 3-6% in large series of PN but there are few reports of the risk factors associated with the development of UF after PN, and the natural history of UF in a large group of patients. PATIENTS AND METHODS This was a retrospective review of 1118PN at one tertiary-care institution. Most patients had a drain placed in the perinephric space after surgery. Fifty-two patients were identified as having a UF if they had persistent flank drainage for >14 days after surgery, or presented with evidence of a UF after the drain had been removed. Risk factors for development and the course of the UF are reported. RESULTS Fifty-two patients developed a UF after PN (4.4%, 95% confidence interval, CI, 3.5-6.1%) The rate of a persistent urine leak (defined as drain fluid consistent with urine for >2 weeks after surgery) was 4.0 (95% CI 2.9-5.3)%. The overall rate of delayed UF presentation was only 0.4 (0.09-0.9)%. Patients who developed a UF had larger tumours (3.5 vs 2.6cm, P = 0.03), a higher estimated blood loss (400 vs 300mL, P < 0.001), and longer ischaemia time (50 vs 39min, P < 0.001) than patients who did not develop a UF. Differences in tumour histology, laterality, multifocality, type of surgery (laparoscopic vs open), and intraoperative collecting system entry were not statistically different in patients who did or did not develop a UF. Patients with tumours of >2.5cm were twice as likely to develop a UF than patients with tumours of <2.5cm (P = 0.02). Most patients were managed conservatively with a percutaneous drain until the UF resolved, if they were asymptomatic. Overall, in 36 patients (69%) the fistula resolved with no intervention, while 16 (31%) required intervention. Stenting was the commonest intervention (15%). No patient required re-operative open surgery. CONCLUSION The rate of development of UF after PN is low. Tumour size, blood loss and ischaemia time were all associated with the development of a UF. In most patients with a urine leak immediately after surgery the UF will resolve with no intervention, and can be managed conservatively with patience, in the absence of clinical symptoms. © 2010 BJU INTERNATIONAL. |
| Keywords: | adult; aged; middle aged; retrospective studies; major clinical study; tumor volume; bleeding; incidence; risk factors; risk factor; kidney neoplasms; nephrectomy; postoperative complication; partial nephrectomy; ischemia; urine incontinence; stent; complications; percutaneous drainage; drainage; urinary tract fistula; urinary fistula |
| Journal Title: | BJU International |
| Volume: | 106 |
| Issue: | 7 |
| ISSN: | 1464-4096 |
| Publisher: | Wiley Blackwell |
| Date Published: | 2010-10-01 |
| Start Page: | 1042 |
| End Page: | 1044 |
| Language: | English |
| DOI: | 10.1111/j.1464-410X.2010.09230.x |
| PUBMED: | 20230384 |
| PROVIDER: | scopus |
| PMCID: | PMC4318244 |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 1" - "Export Date: 20 April 2011" - "CODEN: BJINF" - "Source: Scopus" |
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