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Riikonen J, Pakarainen T, Siltari A, Pienimäki JP, Koskimäki J, Murtola TJ. Urine colour as an indicator for anastomotic leakage after robot-assisted radical prostatectomy. Scand J Urol 2020; 54:201-207. [PMID: 32308088 DOI: 10.1080/21681805.2020.1750474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objectives: To determine whether macroscopic haematuria predicts urethrovesical anastomotic leakage after robot-assisted laparoscopic radical prostatectomy (RALP) as well as a cystogram.Patients and methods: Participants were recruited before cystogram and catheter removal 5-14 days after RALP surgery. Urine colour in the collection bag was classified according to a three-step scale (clear, light red and dark red) and leakages in cystogram were graded with a four-step scale (Grade 0-3). Diagnostic accuracy parameters were calculated for urine colour. A multivariate logistic regression model was used to evaluate other leakage risk factors.Results: Of 214 patients, 201 (94%) had clear, six (3%) had light red and seven (3%) had dark red coloured urine. In the cystogram, 20 (9%) patients had leakage; 14 had Grade 1, five Grade 2 and one Grade 3 leakage. Overall, specificity and sensitivity of urine colour in predicting anastomotic leakage were 0.97 (95% CI = 0.95-100) and 0.38 (95% CI = 0.17-0.59), respectively. Negative and positive predictive values were 94% and 62%, respectively. Other significant risk factors for anastomotic leakage were previous transurethral resection or radiation therapy to the prostate, non-waterproof anastomosis at surgery, postoperative pelvic haematoma, long catheterization and surgeon's inexperience. In patients with no other risk factors, test sensitivity improved to 0.80 (95% CI = 0.45-1.15) and negative and positive predictive values to 99% and 44%, respectively.Conclusion: This prospective single-arm trial indicates that in patients with clear urine and no other risk factors for anastomotic leakage, a cystogram examination before urethral catheter removal can be safely omitted.
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Affiliation(s)
- Jarno Riikonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,TAYS Cancer Center, Department of Urology, Tampere University Hospital, Tampere, Finland
| | - Tomi Pakarainen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,TAYS Cancer Center, Department of Urology, Tampere University Hospital, Tampere, Finland
| | - Aino Siltari
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Juha-Pekka Pienimäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Medical Imaging Center, Tampere University Hospital, Tampere, Finland
| | - Juha Koskimäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,TAYS Cancer Center, Department of Urology, Tampere University Hospital, Tampere, Finland
| | - Teemu J Murtola
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,TAYS Cancer Center, Department of Urology, Tampere University Hospital, Tampere, Finland.,Department of Surgery, Seinäjoki Central Hospital, Seinäjoki, Finland
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Riikonen J, Kaipia A, Matikainen M, Koskimäki J, Kylmälä T, Tammela TL. Side-fenestrated catheter decreases leakage at the urethrovesical anastomosis after robot-assisted laparoscopic radical prostatectomy. Scand J Urol 2013; 48:21-6. [DOI: 10.3109/21681805.2013.777365] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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