The Watertightness of the Anastomosis After Laparoscopic or Robot-Assisted Pyeloplasty: Is a Drainage Necessary?

OBJECTIVE: To determine whether or not temporary drainage is necessary immediately following laparoscopic (lap) and robot-assisted (rob) pyeloplasty (PP). PATIENTS AND METHODS: Of 99 patients undergoing lap PP (n = 23) or rob PP (n = 76) for treatment of ureteropelvic junction obstruction (UPJO), 52 had no drainage, 47 were given an "easy-flow" drain (EFD). The volume of leaking urine (in mL) was defined as the volume of drainage fluid (in mL) × creatinine concentration in drainage fluid (in µmol/mL)/median urine creatinine concentration (in µmol/mL). An anastomosis was considered to be leaking if the volume of leaking urine exceeded 5 mL/24 hours. During follow-up the PP success rate was evaluated based on clinical symptoms, intravenous urography and diuretic renography for detection of persisting obstruction. RESULTS: Median creatinine concentration in drainage fluid was 90 µmol/L (range 44-6270 µmol/L) in a median volume of 84 mL (range 5-1400 mL) drained fluid in 24 hours. The median leaking urine volume was 1.18 mL (range 0.07-291.34 mL), a leaking anastomosis was diagnosed in 5/47 (11%) patients. In patients with EFD and without EFD, complications occurred in 15% and 8% (p = 0.342), respectively, with success rates of 98% and 100% (p = 0.475). Complications (Clavien I-III) occurred in 4/42 (9.5%) patients with watertight and in 3/5 (60%) patients with leaking anastomosis (p = 0.019). No statistically significant differences were noted between lap PP and rob PP patients regarding complication and success rates. CONCLUSION: Lap PP and rob PP were primary watertight in 89% of all patients. A primary leaking anastomosis had no influence on PP outcome, but was associated with a higher risk of complications. However, neither the success rate nor the complication rate differed between drained and undrained patients. We conclude, therefore, that drainage is not necessary.

Extended pelvic lymphadenectomy and various radical prostatectomy techniques: is pelvic drainage necessary?

UNLABELLED: WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: The occurence of lymphoceles in patients after radical prostatectomy is well known (2-10%). It appears that patients undergoing open extraperitoneal radical prostatectomy develop more lymphoceles than patients undergoing robot-assisted radical prostatectomy with transperitoneal access. The present study investigates in a prospective randomized manner whether the time of drainage (1 vs 7 days) makes a difference or whether drainage is even necessary. The study data, collected in the same institution, are compared with the incidence of lymphocele in patients treated by robot-assisted radical prostatectomy. OBJECTIVE: To investigate whether routine drainage is advisable after open extended pelvic lymph node dissection (ePLND) and retropubic radical prostatectomy (RRP) by measuring the incidence of lymphoceles and comparing these results with those of a series of robot-assisted radical prostatectomy (RARP) and ePLND. PATIENTS AND METHODS: A total of 331 consecutive patients underwent ePLND and RRP or RARP. The first 132 patients underwent open ePLND and RRP and received two pelvic drains; these patients were prospectively randomized into two groups: group 1 (n = 66), in which the drains were shortened on postoperative (PO) days 3 and 5 and removed on PO day 7, and group 2 (n = 66), in which the drains were removed on PO day 1. The next 199 patients were assigned to two consecutive groups not receiving drainage: group 3 (n = 73) undergoing open ePLND and RRP, followed by group 4 (n = 126) treated by transperitoneal robot-assisted ePLND and RARP. All patients had ultrasonographic controls 5 and 10 days and 3 and 12 months after surgery. RESULTS: Lymphoceles were detected in 6.6% of all patients, 3.3% of whom were asymptomatic and 3.3% of whom were symptomatic. Symptomatic lymphoceles were detected in 0% of group 1, 8% of group 2, 7% of group 3 and 1% of group 4, with groups 2 and 3 differing significantly from group 4 (P < 0.05). In total, 5% of all patients undergoing open RRP (groups 1-3) had symptomatic lymphoceles vs 1% of patients undergoing RARP (group 4) (P = 0.06). Nodal-positive patients had significantly more symptomatic lymphoceles than nodal-negative patients (10% vs 2%) (P < 0.02). CONCLUSIONS: Symptomatic lymphoceles occur less frequently after open RRP and pelvic drainage over 7 days than after open RRP and pelvic drainage over 1 day or without drainage. Patients undergoing RARP without drainage had significantly fewer lymphoceles than patients receiving open RRP without drainage.