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Urinary fistulae after partial nephrectomy
Author(s) -
Kundu Shilajit D.,
Thompson R. Houston,
Kallingal George J.,
Cambareri Gina,
Russo Paul
Publication year - 2010
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2010.09230.x
Subject(s) - medicine , nephrectomy , adipose capsule of kidney , surgery , urinary system , confidence interval , incidence (geometry) , fistula , retrospective cohort study , kidney , physics , optics
Study Type – Therapy (case series)
Level of Evidence 4 OBJECTIVE To report the risk factors and natural history of urinary fistula (UF) after partial nephrectomy (PN), as their incidence has been reported to be 3–6% in large series of PN but there are few reports of the risk factors associated with the development of UF after PN, and the natural history of UF in a large group of patients. PATIENTS AND METHODS This was a retrospective review of 1118 PN at one tertiary‐care institution. Most patients had a drain placed in the perinephric space after surgery. Fifty‐two patients were identified as having a UF if they had persistent flank drainage for >14 days after surgery, or presented with evidence of a UF after the drain had been removed. Risk factors for development and the course of the UF are reported. RESULTS Fifty‐two patients developed a UF after PN (4.4%, 95% confidence interval, CI, 3.5–6.1%) The rate of a persistent urine leak (defined as drain fluid consistent with urine for >2 weeks after surgery) was 4.0 (95% CI 2.9–5.3)%. The overall rate of delayed UF presentation was only 0.4 (0.09–0.9)%. Patients who developed a UF had larger tumours (3.5 vs 2.6 cm, P = 0.03), a higher estimated blood loss (400 vs 300 mL, P < 0.001), and longer ischaemia time (50 vs 39 min, P < 0.001) than patients who did not develop a UF. Differences in tumour histology, laterality, multifocality, type of surgery (laparoscopic vs open), and intraoperative collecting system entry were not statistically different in patients who did or did not develop a UF. Patients with tumours of >2.5 cm were twice as likely to develop a UF than patients with tumours of <2.5 cm ( P = 0.02). Most patients were managed conservatively with a percutaneous drain until the UF resolved, if they were asymptomatic. Overall, in 36 patients (69%) the fistula resolved with no intervention, while 16 (31%) required intervention. Stenting was the commonest intervention (15%). No patient required re‐operative open surgery. CONCLUSION The rate of development of UF after PN is low. Tumour size, blood loss and ischaemia time were all associated with the development of a UF. In most patients with a urine leak immediately after surgery the UF will resolve with no intervention, and can be managed conservatively with patience, in the absence of clinical symptoms.