Robotik radikal prostatektomi sonrası üretrovezikal anastomoz kaçağının erken postoperatif kontinans üzerine etkisi

Abstract

Amaç: Bu çalışmada robot yardımlı radikal prostatektomi (RYRP) uygulanan hastalarda üretrovezikal anastomoz kaçağı (UAK) ve ilişkili faktörleri ve bunun erken kontinans üzerine etkisini değerlendirmeyi amaçladık. Gereç ve Yöntemler: Bu retrospektif analizde Şubat 2017 ile Haziran 2022 tarihleri arasında RYRP uygulanan 81 hastanın verileri değerlendirildi. Ameliyat sonrası yedinci günde hastalarda UAK olup olmadığını belirlemek için sistografi çekildi. UAK’ye yol açabilecek faktörleri araştırmak için tek ve çok değişkenli analizler yapıldı. Ameliyattan 6-12 hafta sonra hastalarda kontinans oranları kaydedildi. Bulgular: Toplamda 25 hastada (%31) UAK vardı; 12’si (%15) hafif, 8’i (%10) orta ve 5’i (%6) ileri derecedeydi. Dren/serum kreatinin oranının >1,5 olması ve prostat hacminin >53 cm3 olması UAK’yi öngörmede hem tek değişkenli hem de çok değişkenli analizlerde anlamlı bulundu (sırasıyla p=0,017 ve p=0,046). Postoperatif ikinci veya üçüncü günde dren çıkışı 100 ml’den fazla olan 36 hastanın sekizinde (%22) yüksek dren/serum kreatinin oranı (>1,5) vardı ve bunların yedisinde (%88) UAK vardı. Erken dönem takip verilerine göre UAK’lı hastaların 9 (%36)’sında, UAK’sız hastaların ise 20 (%37)’sinde inkontinans saptandı (p=0,959). Sonuç: Sistografi, RYRP sonrası anastomoz kaçağını tespit etmede etkili bir yöntemdir. Büyük prostat hacmi (>53 cm3) ve yüksek postoperatif dren/serum kreatinin oranı (>1.5) UAK ile ilişkili bulunmuştur. UAK’ın erken kontinans üzerinde etkisi gözlenmemiştir.

Keywords

• anastomoz kaçağı
• idrar kaçırma
• robot yardımlı
• prostatektomi
• sistografi

Impact of urethrovesical anastomotic leakage after robotic radical prostatectomy on early postoperative continence

Abstract

Objective: This study aimed to assess the urethrovesical anastomotic leakage (UAL) and associated factors in patients who underwent robot-assisted radical prostatectomy (RARP) and its effect on early continence. Material and Methods: The data of 81 patients who underwent RARP between February 2017 and June 2022 were evaluated in this retrospective analysis. On the seventh postoperative day, we performed a cystography to determine whether the patients had UAL. Uni- and multivariate analyses were done to investigate the factors that could lead to UAL. Continence rates were recorded in patients at 6-12 weeks after surgery. Results: Overall 25 patients (31%) had UAL; of them 12 (15%) were mild, eight (10%) were moderate, and five (6%) were extensive. A drain/serum creatinine ratio >1.5 and a prostate volume >53 cm3 were determined to be significant in predicting UAL in both the uni- and multivariate analyses (p=0.017 and p=0.046, respectively). On the postoperative second or third day, of the 36 patients who had drain output greater than 100 ml, eight (22%) had a high drain/serum creatinine ratio (>1.5), seven (88%) of which had UAL. According to the early period follow-up data, incontinence was prevalent in 9 (36%) of the patients with UAL and 20 (%37) of the patients without UAL (p=0.959). Conclusion: Cystography is an effective method for detecting leakage after RARP. A large prostate volume (>53 cm3) and a high postoperative drain/serum creatinine ratio (>1.5) were found to be associated with UAL. UAL had no effect on early continence.e

Keywords

• anastomotic leak
• cystography
• prostatectomy
• robot-assisted
• urinary incontinence

References

1. 1. Gnanapragasam VJ, Baker P, Naisby GP, Chadwick D. Identification and validation of risk factors for vesicourethral leaks following radical retropubic prostatectomy. Int J Urol. 2005;12(11):948-52. Epub 2005/12/15. doi: 10.1111/j.1442-2042.2005.01166.x.
2. 2. Ramsden AR, Chodak GW. Can leakage at the vesico-urethral anastomosis be predicted after radical retropubic prostatectomy? BJU Int. 2004;93(4):503-6. Epub 2004/03/11. doi: 10.1111/j.1464-410x.2003.04668.x.
3. 3. Tyritzis SI, Katafigiotis I, Constantinides CA. All you need to know about urethrovesical anastomotic urinary leakage following radical prostatectomy. J Urol. 2012;188(2):369-76. Epub 2012/06/16. doi: 10.1016/j.juro.2012.03.126.
4. 4. Kakutani S, Takeshima Y, Yamada Y et al. Clinical significance and risk factors of urethrovesical anastomotic urinary leakage following robot-assisted radical prostatectomy: a multi-institutional study. BMC Urol. 2021;21(1):75. Epub 2021/05/05. doi: 10.1186/s12894-021-00844-1.
5. 5. Tillier C, van Muilekom HAM, Bloos-van der Hulst J, Grivas N, van der Poel HG. Vesico-urethral anastomosis (VUA) evaluation of short- and long-term outcome after robot-assisted laparoscopic radical prostatectomy (RARP): selective cystogram to improve outcome. J Robot Surg. 2017;11(4):441-6. Epub 2017/01/13. doi: 10.1007/s11701-017-0677-1.
6. 6. Han KS, Choi HJ, Jung DC et al. A prospective evaluation of conventional cystography for detection of urine leakage at the vesicourethral anastomosis site after radical prostatectomy based on computed tomography. Clin Radiol. 2011;66(3):251-6. Epub 2011/02/08. doi: 10.1016/j.crad.2010.08.009.
7. 7. Abrams P, Cardozo L, Fall M et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn. 2002;21(2):167-78. Epub 2002/02/22. doi: 10.1002/nau.10052.
8. 8. Cormio L, Di Fino G, Scavone C et al. Prognostic Factors for Anastomotic Urinary Leakage Following Retropubic Radical Prostatectomy and Correlation With Voiding Outcomes. Medicine (Baltimore). 2016;95(16):e3475. Epub 2016/04/23. doi: 10.1097/md.0000000000003475.

9. 9. Rocco B, Gregori A, Stener S et al. Posterior reconstruction of the rhabdosphincter allows a rapid recovery of continence after transperitoneal videolaparoscopic radical prostatectomy. Eur Urol. 2007;51(4):996-1003. Epub 2006/11/03. doi: 10.1016/j.eururo.2006.10.014.
10. 10. Student V, Jr., Vidlar A, Grepl M et al. Advanced Reconstruction of Vesicourethral Support (ARVUS) during Robot-assisted Radical Prostatectomy: One-year Functional Outcomes in a Two-group Randomised Controlled Trial. Eur Urol. 2017;71(5):822-30. Epub 2016/06/11. doi: 10.1016/j.eururo.2016.05.032.
11. 11. Porpiglia F, Bertolo R, Manfredi M et al. Total Anatomical Reconstruction During Robot-assisted Radical Prostatectomy: Implications on Early Recovery of Urinary Continence. Eur Urol. 2016;69(3):485-95. Epub 2015/08/25. doi: 10.1016/j.eururo.2015.08.005.
12. 12. Coelho RF, Chauhan S, Orvieto MA et al. Corrigendum re: "Influence of Modified Posterior Reconstruction of the Rhabdosphincter on Early Recovery of Continence and Anastomotic Leakage Rates after Robot-Assisted Radical Prostatectomy" [Eur Urol 2011;59:72-80]. Eur Urol. 2018;74(2):e56. Epub 2018/05/24. doi: 10.1016/j.eururo.2018.05.007.
13. 13. Menon M, Muhletaler F, Campos M, Peabody JO. Assessment of early continence after reconstruction of the periprostatic tissues in patients undergoing computer assisted (robotic) prostatectomy: results of a 2 group parallel randomized controlled trial. J Urol. 2008;180(3):1018-23. Epub 2008/07/22. doi: 10.1016/j.juro.2008.05.046.
14. 14. Mattei A, Birkhaeuser FD, Baermann C, Warncke SH, Studer UE. To stent or not to stent perioperatively the ureteroileal anastomosis of ileal orthotopic bladder substitutes and ileal conduits? Results of a prospective randomized trial. J Urol. 2008;179(2):582-6. Epub 2007/12/15. doi: 10.1016/j.juro.2007.09.066.
15. 15. Regmi SK, Bearrick EN, Hannah PTF et al. Drain fluid creatinine-to-serum creatinine ratio as an initial test to detect urine leakage following cystectomy: A retrospective study. Indian J Urol. 2021;37(2):153-8. Epub 2021/06/10. doi: 10.4103/iju.IJU_396_20.
16. 16. Sukkarieh T, Harmon J, Penna F, Parra R. Incidence and management of anastomotic leakage following laparoscopic prostatectomy with implementation of a new anastomotic technique incorporating posterior bladder neck tailoring. J Robot Surg. 2007;1(3):213-5. Epub 2007/01/01. doi: 10.1007/s11701-007-0046-6.
17. 17. Sandhu JS, Gotto GT, Herran LA et al. Age, obesity, medical comorbidities and surgical technique are predictive of symptomatic anastomotic strictures after contemporary radical prostatectomy. J Urol. 2011;185(6):2148-52. Epub 2011/04/19. doi: 10.1016/j.juro.2011.02.003.
18. 18. Dalton DP, Schaeffer AJ, Garnett JE, Grayhack JT. Radiographic assessment of the vesicourethral anastomosis directing early decatheterization following nerve-sparing radical retropubic prostatectomy. J Urol. 1989;141(1):79-81. Epub 1989/01/01. doi: 10.1016/s0022-5347(17)40595-7.
19. 19. Tiguert R, Rigaud J, Fradet Y. Safety and outcome of early catheter removal after radical retropubic prostatectomy. Urology. 2004;63(3):513-7. Epub 2004/03/19. doi: 10.1016/j.urology.2003.10.042.
20. 20. Varkarakis J, Wirtenberger W, Pinggera GM et al. Evaluation of urinary extravasation and results after continence-preserving radical retropubic prostatectomy. BJU Int. 2004;94(7):991-5. Epub 2004/11/16. doi: 10.1111/j.1464-410X.2004.05092.x.
21. 21. Ha YS, Bak DJ, Chung JW et al. Postoperative cystographic findings as an independent predictor of urinary incontinence three months after radical prostatectomy. Minerva Urol Nefrol. 2017;69(3):278-84. Epub 2016/09/30. doi: 10.23736/s0393-2249.16.02763-6.
22. 22. Patil N, Krane L, Javed K et al. Evaluating and grading cystographic leakage: correlation with clinical outcomes in patients undergoing robotic prostatectomy. BJU Int. 2009;103(8):1108-10. Epub 2008/11/22. doi: 10.1111/j.1464-410X.2008.08168.x.
23. 23. Tohi Y, Kohashiguchi K, Miura T et al. Impact of the severity of urethrovesical anastomotic leakage on urinary continence following robot-assisted laparoscopic prostatectomy. J Robot Surg. 2022;16(5):1175-81. Epub 2022/01/30. doi: 10.1007/s11701-021-01357-7.