Mahmud Husny, Erlich Tomer, Zilberman Dorit E, Rosenzweig Barak, Portnoy Orith, Dotan Zohar A
Department of Urology, Faculty of Medicine, Sheba Medical Center, Tel Aviv University, Tel Hashomer, Tel Aviv, Israel.
Department of Urology, The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, 52621, Israel.
World J Urol. 2025 Apr 28;43(1):254. doi: 10.1007/s00345-025-05651-z.
Urine leakage (UL) is a recognized complication after partial nephrectomy (PN). This study aimed to determine the incidence of UL and identify key risk factors, including tumor size and surgical approach, to clarify the impact of robotic-assisted, laparoscopic, and open PN on postoperative outcomes.
A retrospective review of 785 consecutive clinical T1 PN cases (2012-2022) was undertaken. UL was defined as biochemically confirmed uriniferous drain output ≥ 50 mL day-1 persisting ≥ 3 days. The overall incidence of UL was assessed, and multivariable statistical tests evaluated potential predictors of leakage. (19 events; EPV = 3.8; hypothesisgenerating).
Of the 785 patients, 50.7% had RAPN, 33.8% OPN, and 15.5% LPN. The overall incidence of UL was 2.4%. RAPN demonstrated the lowest leakage rate (0.75%), compared with OPN (3.7%) and LPN (4.91%) (p = 0.03), representing a five-fold reduction in UL risk compared to open and laparoscopic approaches. Patients with T1b tumors were significantly more prone to leakage than those with T1a tumors (15.8% vs. 0.99%; multivariable odds ratio (OR) = 18.8, 95% CI = 7.15-49.44; p < 0.0001). Longer operative and ischemia times were also associated with higher leakage risk. All UL cases resolved with conservative or minimally invasive interventions.
Surgical approach, operative duration, ischemia time, and tumor size (T1b vs. T1a) emerged as principal predictors of postoperative UL. RAPN conferred a notably lower leakage risk compared to OPN and LPN, underscoring its advantages for nephron-sparing surgery, particularly in complex renal tumors requiring meticulous collecting-system closure.
Not applicable (retrospective).
尿漏（UL）是部分肾切除术（PN）后一种公认的并发症。本研究旨在确定UL的发生率，并确定关键风险因素，包括肿瘤大小和手术方式，以阐明机器人辅助、腹腔镜和开放PN对术后结果的影响。
对785例连续的临床T1期PN病例（2012 - 2022年）进行回顾性分析。UL定义为经生化确认的尿引流量≥50 mL/天，持续≥3天。评估UL的总体发生率，并通过多变量统计测试评估漏尿的潜在预测因素。（19例事件；预期值 = 3.8；产生假设）。
785例患者中，50.7%接受机器人辅助PN（RAPN），33.8%接受开放PN（OPN），15.5%接受腹腔镜PN（LPN）。UL的总体发生率为2.4%。与OPN（3.7%）和LPN（4.91%）相比，RAPN的漏尿率最低（0.75%）（p = 0.03），与开放和腹腔镜手术方式相比，UL风险降低了五倍。T1b期肿瘤患者比T1a期肿瘤患者更容易发生漏尿（15.8%对0.99%；多变量优势比（OR）= 18.8，95%置信区间 = 7.15 - 49.44；p < 0.0001）。较长的手术时间和缺血时间也与较高的漏尿风险相关。所有UL病例均通过保守或微创干预得到解决。
手术方式、手术持续时间、缺血时间和肿瘤大小（T1b与T1a）是术后UL的主要预测因素。与OPN和LPN相比，RAPN的漏尿风险显著更低，突出了其在保留肾单位手术中的优势，特别是在需要精细缝合集合系统的复杂肾肿瘤中。
不适用（回顾性研究）。
