Zargar Homayoun, Khalifeh Ali, Autorino Riccardo, Akca Oktay, Brandão Luis Felipe, Laydner Humberto, Krishnan Jayram, Samarasekera Dinesh, Haber George-Pascal, Stein Robert J, Kaouk Jihad H
Center for Laparoscopic & Robotic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
Int Braz J Urol. 2014 Nov-Dec;40(6):763-71. doi: 10.1590/S1677-5538.IBJU.2014.06.07.
To investigate risk factors for urine leak in patients undergoing minimally invasive partial nephrectomy (MIPN) and to determine the role of intraoperative ureteral catheterization in preventing this postoperative complication.
MIPN procedures done from September 1999 to July 2012 at our Center were reviewed from our IRB-approved database. Patient and tumor characteristics, operative techniques and outcomes were analyzed. Patients with evidence of urine leak were identified. Outcomes were compared between patients with preoperative ureteral catheterization (C-group) and those without (NC-group). Univariable and multivariable analyses were performed to identify factors predicting postoperative urine leak.
A total of 1,019 cases were included (452 robotic partial nephrectomy cases and 567 laparoscopic partial nephrectomy cases). Five hundred twenty eight patients (51.8%) were in the C-group, whereas 491 of them (48.2%) in the NC-group. Urine leak occurred in 31(3%) cases, 4.6% in the C-group and 1.4% in the NC-group (p<0.001). Tumors in NC-group had significantly higher RENAL score, shorter operative and warm ischemic times. On multivariable analysis, tumor proximity to collecting system (OR=9.2; p<0.01), surgeon's early operative experience (OR=7.8; p<0.01) and preoperative moderate to severe CKD (OR=3.1; p<0.01) significantly increased the odds of the occurrence of a postoperative urine leak.
Clinically significant urine leak after MIPN in a high volume institution setting is uncommon. This event is more likely to occur in cases of renal masses that are close to the collecting system, in patients with preoperative CKD and when operating surgeon is still in the learning curve for the procedure. Our findings suggest that routine intraoperative ureteral catheterization during MIPN does not reduce the probability of postoperative urine leak. In addition, it adds to the overall operative time.
探讨接受微创部分肾切除术（MIPN）患者发生尿漏的危险因素，并确定术中输尿管插管在预防该术后并发症中的作用。
从我们中心经机构审查委员会批准的数据库中回顾1999年9月至2012年7月期间进行的MIPN手术。分析患者和肿瘤特征、手术技术及结果。确定有尿漏证据的患者。比较术前进行输尿管插管的患者（C组）和未进行输尿管插管的患者（NC组）的结果。进行单变量和多变量分析以确定预测术后尿漏的因素。
共纳入1019例病例（452例机器人辅助部分肾切除术病例和567例腹腔镜部分肾切除术病例）。528例患者（51.8%）在C组，而491例患者（48.2%）在NC组。31例（3%）发生尿漏，C组为4.6%，NC组为1.4%（p<0.001）。NC组肿瘤的RENAL评分显著更高，手术时间和热缺血时间更短。多变量分析显示，肿瘤与集合系统的距离（OR=9.2；p<0.01）、外科医生的早期手术经验（OR=7.8；p<0.01）和术前中度至重度慢性肾脏病（OR=3.1；p<0.01）显著增加术后尿漏发生的几率。
在大容量机构环境中，MIPN术后具有临床意义的尿漏并不常见。这种情况更有可能发生在靠近集合系统的肾肿块病例、术前患有慢性肾脏病的患者以及手术医生仍处于该手术学习曲线阶段时。我们的研究结果表明，MIPN术中常规输尿管插管并不能降低术后尿漏的概率。此外，它还会增加总手术时间。
