Total prostatectomy and lymph node dissection may be done safely without pelvic drainage: an extended experience of over 600 cases.

OBJECTIVES: Routine placement of a pelvic drain may be avoided after total prostatectomy, traditionally known as "radical retropubic prostatectomy", with lymph node dissection (TP/LND). From our experience with 846 patients, we contend that patient safety and efficacy is not compromised by selectively omitting a pelvic drain.
MATERIALS AND METHODS: TP/LND was performed in 846 patients with clinically localized prostate adenocarcinoma. Patient demographics, clinical and pathological data were recorded and relevant data was analyzed. After the prostate was removed and the anastomotic sutures tied, saline was instilled into the bladder through the urethral catheter. If there was no significant leakage, hemostasis was adequate, and there was no injury to adjacent organs, a drain was omitted.
RESULTS: A drain was omitted in 624 (74%) of the 846 patients. The postoperative complication rates were compared between those with (D+) and without (D-) a drain. In the latter group, there were 24 (4%) immediate postoperative complications without a significant difference between the two groups (D+, 6%; D-, 4%; p = 0.25). When comparing the incidence of urinary retention, hematuria, anastomotic stricture, pelvic fluid collections, hematuria, and thrombolic events, there was no significant difference between patients with and without a drain.
CONCLUSIONS: The morbidity of TP/LND is low when performed by an experienced surgeon. When the urethrovesical anastomosis is watertight and hemostasis is assured, a pelvic drain may be omitted without compromising patient safety and efficacy.