Sangjun Yoo1, Dalsan You2, In Gab Jeong2, Cheryn Song2, Bumsik Hong2, Jun Hyuk Hong2, Hanjong Ahn2, Choung-Soo Kim3. 1. Department of Urology, Seoul National University Boramae Medical Center, Seoul, South Korea. 2. Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. 3. Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. Electronic address: cskim@amc.seoul.kr.
Abstract
INTRODUCTION: We aimed to evaluate the impact of preoperative ureteral catheter insertion on urinary leakage after partial nephrectomy (PN) in patients with renal cell carcinoma. METHODS: We reviewed the data of 893 patients with renal cell carcinoma who underwent PN and divided them according to ureteral catheter placement. The impact of ureteral catheter placement on postoperative urinary leakage was evaluated by using multivariate analysis. RESULTS: Ureteral catheters were inserted in 397 (44.5%) patients. Patients with ureteral catheter insertion had larger tumors (2.4 vs. 2.6 cm; P = .031); however, the RENAL nephrometry scores were comparable (P = .131). Robotic PN was more common in patients with ureteral catheters (11.1 vs. 53.9%; P < .001). Urinary leakage did not differ according to ureteral catheter placement (3.4 vs. 3.5%; P = .936). Although tumor size (P = .002), ureteral catheter insertion (P < .001), and operative methods (P < .001) were significantly different according to surgeons, the rate of urinary leakage was similar (surgeon A: 4.0%, surgeon B: 4.6%, surgeon C: 1.5%, others: 2.9%; P = .294). In multivariate analysis of preoperative variables, age and RENAL nephrometry scores were associated with urinary leakage. In multivariate analysis of preoperative and intraoperative variables, the operative method, collecting system status, and intraoperative transfusion, but not ureteral catheter insertion, were related to urinary leakage. CONCLUSIONS: Ureteral catheter insertion does not appear to reduce the risk of urinary leakage after PN, and visibility during PN with meticulous bleeding control is important in preventing urinary leakage after PN.
INTRODUCTION: We aimed to evaluate the impact of preoperative ureteral catheter insertion on urinary leakage after partial nephrectomy (PN) in patients with renal cell carcinoma. METHODS: We reviewed the data of 893 patients with renal cell carcinoma who underwent PN and divided them according to ureteral catheter placement. The impact of ureteral catheter placement on postoperative urinary leakage was evaluated by using multivariate analysis. RESULTS: Ureteral catheters were inserted in 397 (44.5%) patients. Patients with ureteral catheter insertion had larger tumors (2.4 vs. 2.6 cm; P = .031); however, the RENAL nephrometry scores were comparable (P = .131). Robotic PN was more common in patients with ureteral catheters (11.1 vs. 53.9%; P < .001). Urinary leakage did not differ according to ureteral catheter placement (3.4 vs. 3.5%; P = .936). Although tumor size (P = .002), ureteral catheter insertion (P < .001), and operative methods (P < .001) were significantly different according to surgeons, the rate of urinary leakage was similar (surgeon A: 4.0%, surgeon B: 4.6%, surgeon C: 1.5%, others: 2.9%; P = .294). In multivariate analysis of preoperative variables, age and RENAL nephrometry scores were associated with urinary leakage. In multivariate analysis of preoperative and intraoperative variables, the operative method, collecting system status, and intraoperative transfusion, but not ureteral catheter insertion, were related to urinary leakage. CONCLUSIONS: Ureteral catheter insertion does not appear to reduce the risk of urinary leakage after PN, and visibility during PN with meticulous bleeding control is important in preventing urinary leakage after PN.