Urinary leakage after laparoscopic radical prostatectomy: a systematic review.

PURPOSE: To review the literature on the definition and incidence of leakage after laparoscopic radical prostatectomy (LRP) as well as its relation to the surgeon's technical experience, the type of urethrovesical suture, and the approach (extraperitoneal or transperitoneal). MATERIALS AND METHODS: We conducted a systematic review of the subject, consulting MEDLINE, Embase, and Cochrane library (MeSH terms "radical prostatectomy," "laparoscopy," "anastomotic leakage," and "complications"). Languages were limited to English, Spanish, and French. Selection criteria were original papers with 30 or more patients and description of the leakage rate. Data on mean catheterization days, surgical approach, and type of suture were retrieved. Papers were included after approval by two independent reviewers. Statistical analysis was performed with SPSS V. 12. A P value <0.05 was considered significant. RESULTS: A total of 24 articles were identified meeting the inclusion criteria. Most of them were observational. There were no randomized controlled trials. Meta-analysis was not performed because of clinical heterogeneity. Leakage was defined in 11 of the papers, and great variation in the definition was found. On average, the incidence of anastomotic leakage was 9.7% (396/4091 patients) and ranged from 3.2% to 33%. None of the risk factors studied showed statistical significance, although some individual series demonstrated a decrease in the leakage rate with increasing surgeon experience. CONCLUSIONS: The evidence in the studies on urine leakage after LRP is poor. There is a lack of a uniform definition of the condition. Time frame, diagnostic method, and significance need to be standardized. This lack of definition, together with the character of the studies and the heterogeneity of the series, makes comparison difficult, precluding a proper meta-analysis.

Present practice and treatment strategies in endourological stone management: results of a survey of the European Society of Uro-technology (ESUT).

OBJECTIVES: The European Society of Urological Technology (ESUT) conducted a survey in order to assess and record the current trends between urologists with regard to the application of endourological stone management to identify trends and differences in treatment strategies among urologists. METHODS: A total of 695 certified urologists and urological residents answered the ESUT Endourological Stone Management Questionnaire. There were 136 (28.7%) chief urologists, 240 (50.6%) staff urologists and 98 (20.7%) residents. The respondents were classified according to both the geographical origin (in four groups: Northern Europe (NE), Southern Europe (SE), Eastern Europe (EE) and Outside Europe (OE)), and department size (number of urological beds per department: small < or = 25, medium 26-50 beds, large > 50 beds) in order to identify any differences in the replies. RESULTS: On average, 40.1 newly diagnosed patients and 73.6 revisits with urolithiasis are seen a month per department. According to the replies, there are no significant differences in total numbers of treatments in ESWL and/or endourological stone managements amongst the geographically based groups. Monthly, on average 68.5 ESWL treatments and 23.0 URS are performed per department. A significant majority of surveyed urologists performs URS with a rigid or semi-rigid instrument (79%) instead of a flexible instrument (21%, p = 0.003). URS is more frequently performed outside Europe (p = 0.02) with a more frequent use of dormia catheters (p < 0.001). On average, 20.9 double g-stents are placed monthly in each department, most commonly before or after endourological procedures (p < 0.001). Percutaneous procedures are performed by 69.6% of the respondents with a mean of 16.8 PNL procedures a month. PNL for stone management is mainly performed in Eastern Europe and non-European countries (p = 0.017). Nephrostomy tubes are used by 77.7% of the responding urologists. Monthly, 13.1 nephrostomy tubes are placed, mostly during PNL or after endourological procedures (40.7%). CONCLUSION: The data obtained from the 695 urologists and residents provides information on the performed procedures and the use of material. In general, respondents from different geographical locations perform similar procedures and use identical material; however URS and PNL are performed more frequently outside of Europe, whereas laser lithotripsy is frequently used in Northern European counties.