Schenck M, Schneider T
Uro-Radio-Onkologie, Klinik und Poliklinik für Urologie, Kinderurologie und urologische Onkologie, Universitätsklinikum Essen, Hufelandstrasse 55, 45122 Essen.
Urologe A. 2010 Mar;49(3):364-8. doi: 10.1007/s00120-010-2270-3.
After radical prostatectomy, urinary extravasation at the anastomosis is common. Nevertheless, no data exist regarding the optimal time for catheter removal at the time of expected complete healing of the leakage. Therefore, over the last 10 years we have developed a standardized way to check the healing of the anastomosis. From 1999 to 2008, 1,479 radical prostatectomies were performed. Of those, 752 could be evaluated using the standardized method of checking the anastomosis for complete healing. All patients were postoperatively evaluated by cystogram. The date for checking the anastomosis/extravasation was determined by the color of the urine (cloudy, clear, or bloody). In the 752 evaluated patients (mean age 64 years), urinary extravasation was detected 2-8 days postoperatively in 41%, 9-12 days postoperatively in 16%, and in no patient 21 days postoperatively. The measured volume of urinary extravasation after 2-8 days postoperatively was 15 ml (3-49 ml) using cystogram evaluation. After 9-12 days, the volume was determined by cystogram to be 9 ml (3-24 ml). Macroscopic evaluation of the urinary color correlated very well with the likelihood of extravasation still being present. When the urine was cloudy or colored by old blood, extravasation was present in 86% of the patients (predictive value 0.99, specificity 97%). Microscopic evaluation of the urine on the same day showed that significant leukocyturia or hematuria correlated with persistent extravasation in 49% of the patients (sensitivity 98%, specificity 34%). The transurethral catheter remained in place for a mean of 7.9 days (4-31 days). After radical prostatectomy, the macroscopic color of the urine is evaluated as a single criterion for determining the time for assessing for possible persisting leakage of the anastomosis. Microscopic urine evaluation is less effective.
根治性前列腺切除术后，吻合口处尿外渗很常见。然而，关于漏口预期完全愈合时拔除导尿管的最佳时间，目前尚无相关数据。因此，在过去10年里，我们开发了一种标准化方法来检查吻合口的愈合情况。1999年至2008年期间，共进行了1479例根治性前列腺切除术。其中，752例可采用标准化方法检查吻合口是否完全愈合进行评估。所有患者术后均通过膀胱造影进行评估。检查吻合口/尿外渗的日期根据尿液颜色（浑浊、清澈或血性）确定。在752例接受评估的患者（平均年龄64岁）中，41%的患者在术后2 - 8天检测到尿外渗，16%的患者在术后9 - 12天检测到尿外渗，术后21天无一例患者检测到尿外渗。术后2 - 8天通过膀胱造影评估测得的尿外渗量为15毫升（3 - 49毫升）。术后9 - 12天，通过膀胱造影确定的尿外渗量为9毫升（3 - 24毫升）。尿液的宏观评估与仍存在尿外渗的可能性相关性非常好。当尿液浑浊或呈陈旧性血液颜色时，86%的患者存在尿外渗（预测值0.99，特异性97%）。同一天对尿液进行显微镜评估显示，49%的患者中显著的白细胞尿或血尿与持续性尿外渗相关（敏感性98%，特异性34%）。经尿道导尿管平均留置7.9天（4 - 31天）。根治性前列腺切除术后，尿液的宏观颜色被评估为确定评估吻合口可能持续漏尿时间的单一标准。显微镜下尿液评估效果较差。
