Peyton Charles C, Hajiran Ali, Morgan Kevin, Azizi Mounsif, Tang Dominic, Chipollini Juan, Gilbert Scott M, Poch Michael, Sexton Wade J, Spiess Philippe E
Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida, USA.
Can J Urol. 2020 Feb;27(1):10118-10124.
To describe the incidence, contemporary management, risk factors and outcomes of urinary leak following open and robotic partial nephrectomy at a tertiary care, comprehensive cancer center.
We reviewed 975 patients who underwent partial nephrectomy at Moffitt Cancer Center from January 2009 to May 2017. Patient demographic, perioperative and follow up data was recorded and compared stratified for postoperative urine leak. Fisher's exact and Wilcoxon sum-rank testing were performed for categorical and continuous variables as indicated.
Twenty-three of 975 (2.3%) patients experienced a urine leak after partial nephrectomy. Median nephrometry score for urine leak patients was 8 (SD +/- 1.3). Median postoperative days to detection was 3.5 and most leaks were discovered due to high drain output. Operative factors associated with urinary leak included open surgery, estimated blood loss, and not using a sliding-clip renorrhaphy (p < 0.05). Ten (44%) were managed conservatively, 9 (39%) patients required ureteral stent placement, 3 (13%) needed a percutaneous nephrostomy tube, one patient (4%) required percutaneous drainage for urinoma (4%). One patient ultimately failed conservative management and required nephrectomy 45 days after the original surgery. Mean time to stent and drain removal was 40 +/- 17 and 24 +/- 7 days, respectively. Five patients with symptomatic leaks were readmitted with a mean length of stay of 3.2 +/- 1.8 days.
The overall incidence of urinary leak after partial nephrectomy remains low regardless of surgical approach. Perioperative characteristics such as tumor complexity and high blood loss, in addition to open surgery and not using a sliding-clip bolstered renorrhaphy are associated with urine leak.
描述在一家三级医疗综合癌症中心行开放性和机器人辅助部分肾切除术后尿漏的发生率、当代治疗方法、危险因素及预后。
我们回顾了2009年1月至2017年5月在莫菲特癌症中心接受部分肾切除术的975例患者。记录患者的人口统计学、围手术期及随访数据，并按术后尿漏情况进行分层比较。对分类变量和连续变量分别进行Fisher精确检验和Wilcoxon秩和检验。
975例患者中有23例（2.3%）在部分肾切除术后发生尿漏。尿漏患者的肾测量评分中位数为8（标准差±1.3）。术后发现尿漏的中位天数为3.5天，大多数尿漏是由于引流液量多而被发现。与尿漏相关的手术因素包括开放性手术、估计失血量以及未使用滑动夹肾缝合术（p<0.05）。10例（44%）采用保守治疗，9例（39%）患者需要放置输尿管支架，3例（13%）需要放置经皮肾造瘘管，1例患者（4%）因尿瘤需要经皮引流。1例患者最终保守治疗失败，在初次手术后45天需要进行肾切除术。支架和引流管拔除的平均时间分别为40±17天和24±7天。5例有症状性尿漏的患者再次入院，平均住院时间为3.2±1.8天。
无论手术方式如何，部分肾切除术后尿漏的总体发生率仍然较低。除开放性手术以及未使用滑动夹加强肾缝合术外，肿瘤复杂性和大量失血等围手术期特征与尿漏相关。
