Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
TAYS Cancer Center, Department of Urology, Tampere University Hospital, Tampere, Finland.
Scand J Urol. 2020 Jun;54(3):201-207. doi: 10.1080/21681805.2020.1750474. Epub 2020 Apr 20.
To determine whether macroscopic haematuria predicts urethrovesical anastomotic leakage after robot-assisted laparoscopic radical prostatectomy (RALP) as well as a cystogram. Participants were recruited before cystogram and catheter removal 5-14 days after RALP surgery. Urine colour in the collection bag was classified according to a three-step scale (clear, light red and dark red) and leakages in cystogram were graded with a four-step scale (Grade 0-3). Diagnostic accuracy parameters were calculated for urine colour. A multivariate logistic regression model was used to evaluate other leakage risk factors. Of 214 patients, 201 (94%) had clear, six (3%) had light red and seven (3%) had dark red coloured urine. In the cystogram, 20 (9%) patients had leakage; 14 had Grade 1, five Grade 2 and one Grade 3 leakage. Overall, specificity and sensitivity of urine colour in predicting anastomotic leakage were 0.97 (95% CI = 0.95-100) and 0.38 (95% CI = 0.17-0.59), respectively. Negative and positive predictive values were 94% and 62%, respectively. Other significant risk factors for anastomotic leakage were previous transurethral resection or radiation therapy to the prostate, non-waterproof anastomosis at surgery, postoperative pelvic haematoma, long catheterization and surgeon's inexperience. In patients with no other risk factors, test sensitivity improved to 0.80 (95% CI = 0.45-1.15) and negative and positive predictive values to 99% and 44%, respectively. This prospective single-arm trial indicates that in patients with clear urine and no other risk factors for anastomotic leakage, a cystogram examination before urethral catheter removal can be safely omitted.
为了确定肉眼血尿是否能预测机器人辅助腹腔镜根治性前列腺切除术（RALP）后尿道膀胱吻合口漏以及膀胱造影。参与者在膀胱造影前和 RALP 手术后 5-14 天拔除导尿管时招募。收集袋中的尿液颜色根据三步法（清澈、淡红色和深红色）进行分类，膀胱造影中的漏液根据四步法分级（0-3 级）。计算了尿液颜色的诊断准确性参数。使用多变量逻辑回归模型评估其他漏液危险因素。在 214 名患者中，201 名（94%）尿液清澈，6 名（3%）尿液淡红色，7 名（3%）尿液深红色。在膀胱造影中，20 名（9%）患者有漏液；14 名患者为 1 级，5 名患者为 2 级，1 名患者为 3 级漏液。总体而言，尿液颜色预测吻合口漏的特异性和敏感性分别为 0.97（95%CI=0.95-100）和 0.38（95%CI=0.17-0.59）。阴性和阳性预测值分别为 94%和 62%。吻合口漏的其他显著危险因素包括前列腺既往经尿道切除术或放疗、手术时非防水吻合、术后盆腔血肿、长时间置管和术者经验不足。在没有其他危险因素的患者中，试验敏感性提高至 0.80（95%CI=0.45-1.15），阴性和阳性预测值分别提高至 99%和 44%。这项前瞻性单臂试验表明，在无肉眼血尿且无吻合口漏其他危险因素的患者中，在拔除尿道导尿管前进行膀胱造影检查可以安全省略。
