Rutgers New Jersey Medical School, Newark, NJ, USA.
Department of Urology, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA.
J Robot Surg. 2024 Oct 29;18(1):387. doi: 10.1007/s11701-024-02096-1.
Urine leak (UL) and vascular complications (VC), i.e., pseudoaneurysms and arteriovenous fistulas are well-described complications of robotic-assisted partial nephrectomy (RAPN). Historically, UL incidence ranges from 0.3 to 17% and VC from 0.8 to 5.6%. We report the contemporary experience of UL and VC from a single, high-volume center in cases of RAPN. 447 patients were identified from an IRB-approved Renal Tumor Database of 2174 cases who underwent RAPN from 1/2017 to 5/2023. VC occurred in 9 cases (4 pseudoaneurysms, 1 AV fistula, 4 concurrent AV fistula/pseudoaneurysm), UL occurred in 9 (2.0%), and there was one concurrent case of VC and UL. Collecting-system entry occurred in five VC cases and five UL cases. For VCs, the median nephrometry score and maximal tumor diameter was 8 (IQR 3.0) and 3.8 (0.9) cm, respectively, and 8 (3.0) and 3.7 (1.1) cm for UL cases, respectively. Most complications occurred with tumors ≤ 4 mm from the collecting system (n = 7 VC, n = 6 UL). VCs presented after 18 (6.0) days, 6 with gross hematuria; 3 required clot irrigation, 1 required continuous bladder irrigation, and 8 required embolization. No patients required postoperative transfusion. Patients with UL presented after a median of 1 (12) day, with 5 cases detected by elevated creatinine in drain fluid and the remainder detected on routine ultrasound. The duration of UL was 13 (41) days with only 2 cases requiring stenting and one case requiring a drainage catheter. No patients required kidney re-operation or removal. Our rate of VC and UL following RAPN are low and consistent with other contemporary series. Complications occurred in patients with high nephrometry scores or tumors located close to the collecting system. Both complications generally present early and can be managed without kidney re-operation or removal.
尿漏 (UL) 和血管并发症 (VC)，即假性动脉瘤和动静脉瘘，是机器人辅助部分肾切除术 (RAPN) 中描述的常见并发症。历史上，UL 的发生率为 0.3%至 17%，VC 为 0.8%至 5.6%。我们报告了一家高容量中心的 RAPN 中 UL 和 VC 的当代经验。从 2017 年 1 月至 2023 年 5 月期间，对 2174 例接受 RAPN 的患者进行了一项经机构审查委员会批准的肾脏肿瘤数据库研究，共确定了 447 例患者。9 例发生 VC（4 例假性动脉瘤、1 例动静脉瘘、4 例同时发生动静脉瘘/假性动脉瘤），9 例发生 UL，1 例同时发生 VC 和 UL。集合系统进入发生在 5 例 VC 和 5 例 UL 病例中。对于 VC，中位数肾切除术评分和最大肿瘤直径分别为 8（IQR 3.0）和 3.8（0.9）cm，UL 病例分别为 8（3.0）和 3.7（1.1）cm。大多数并发症发生在肿瘤距集合系统 ≤ 4mm 处（n=7 VC，n=6 UL）。VC 发生在 18（6.0）天后，6 例有肉眼血尿；3 例需要血块冲洗，1 例需要持续膀胱冲洗，8 例需要栓塞。没有患者需要术后输血。UL 中位出现时间为 1（12）天，5 例患者因引流液中肌酐升高而发现，其余患者在常规超声检查中发现。UL 的持续时间为 13（41）天，只有 2 例需要支架，1 例需要引流管。没有患者需要肾脏再次手术或切除。我们的 RAPN 后 VC 和 UL 发生率较低，与其他当代系列一致。并发症发生在肾切除术评分较高或肿瘤靠近集合系统的患者中。这两种并发症通常都较早出现，可以在不需要肾脏再次手术或切除的情况下进行治疗。
