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Identification and validation of risk factors for vesicourethral leaks following radical retropubic prostatectomy
Author(s) -
GNANAPRAGASAM VINCENT J,
BAKER PAUL,
NAISBY GEOFFREY P,
CHADWICK DAVID
Publication year - 2005
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1111/j.1442-2042.2005.01166.x
Subject(s) - medicine , cystography , radical retropubic prostatectomy , prostatectomy , anastomosis , prospective cohort study , leak , cohort , surgery , retrospective cohort study , urology , urinary system , prostate cancer , cancer , environmental engineering , engineering
Aims: To identify risk factors for anastomotic leaks at cystography following radical retropubic prostatectomy (RRP). Methods: In phase 1 the records of a 107 RRP patients were reviewed. Data collected included comorbidity, pathological factors and intra‐ and postoperative complications. From these, risk factors were identified that were associated with a leak at cystography. In phase 2 ( n = 46) we prospectively tested if the risk factors identified could predict an anastomotic leak. Results: In phase 1 the only identifiable risk factors were that of a difficult anastamosis, an unsatisfactory intraoperative test flush and the presence of a urinary tract infection. One or more of these events were found in 17/25 (68%) of the patients who leaked ( P < 0.0001). Of the eight leaks missed, five were classed as minimal and did not require repeat cystography. Within the prospective phase 2 cohort one or more risk factors were present in 7/10 (70%) of the patients who leaked. In contrast, the identified risk factors were present in only 5/36 (13.8%) of the patients who did not leak ( P < 0.001). The specificity of the test was 86.1% with a sensitivity of 70%. This gave a positive predictive value of 58.3% and a negative predictive value of 91.1%. Three leaks (two minimal and one moderate) would have been missed but 31 (67.3%) patients would have avoided an unnecessary radiological study. Conclusion: Using a retrospective and prospective cohort of patients we have shown that a cystogram following RRP can be safely avoided in the absence of the identified risk factors.