1434 IDENTIFYING COLLECTING SYSTEM ENTRY AND THE INTEGRITY OF REPAIR DURING OPEN PARTIAL NEPHRECTOMY: COMPARISON OF TWO TECHNIQUES

Abstract

You have accessJournal of UrologyKidney Cancer: Localized III1 Apr 20121434 IDENTIFYING COLLECTING SYSTEM ENTRY AND THE INTEGRITY OF REPAIR DURING OPEN PARTIAL NEPHRECTOMY: COMPARISON OF TWO TECHNIQUES Sammy Moussly, Sandhya R. Rao, Michelle Pacheco, Philippe E. Spiess, and Wade J. Sexton Sammy MousslySammy Moussly TAMPA, FL More articles by this author , Sandhya R. RaoSandhya R. Rao TAMPA, FL More articles by this author , Michelle PachecoMichelle Pacheco TAMPA, FL More articles by this author , Philippe E. SpiessPhilippe E. Spiess TAMPA, FL More articles by this author , and Wade J. SextonWade J. Sexton TAMPA, FL More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1907AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Nephron sparing surgery is the current treatment standard for most small renal masses. The resection of deeply endophytic tumors often entails entry into the collecting system which if not recognized and repaired may lead to the development of a postoperative urinary fistula. Some investigators advocate the placement of an externalized ureteral catheter with retrograde dye injection to recognize calyceal entry and/or to test the integrity of the repair whereas others use needle injection of dye directly into the proximal ureter. This study compares the two techniques with regard to perioperative outcomes. METHODS We retrospectively reviewed the records of 259 consecutive patients who underwent open partial nephrectomy from 2005 to 2010. Patients undergoing laparoscopic or robotic assisted partial nephrectomy were not included in the review. Externalized ureteral catheters were placed preoperatively in 110 patients (Group 1) and needle injection of methylene blue was used in 120 patients (Group 2). No assessment of collecting system integrity was performed in 29 patients (Group 3). We compared intraoperative parameters including tumor size, EBL, ischemia time, operative time, recognized entry into the collecting system as well as the incidence of postoperative urinary leaks. RESULTS The average tumor size was 3.1 cm in Group 1, 3.6 cm in Group 2 and 3.8 cm in Group 3 (p=0.04 between groups 1 and 2); mean EBL was 320 cc, 351 cc and 376 cc (p =0.5); mean warm ischemia time was 19.6 mins, 27 mins and 22.5 mins (p<0.001); mean operative time was 193.5 mins, 221 mins and 290 mins (p<0.001); and the mean hospital stay was 5 days in each of the groups. Collecting system entry was recognized in 69 cases (63%) in Group 1 compared to 91 (76%) in Group 2 and 11 (38%) in Group 3 (p=0.07). Postoperative urine leak requiring any form of management (prolonged JP drain, JJ stent, Foley catheter) occurred in 11 patients from group 1 and 6 from group 2. (p=0.07). None of the patients in group 3 developed a urinary leak. CONCLUSIONS The perioperative leak rate in patients undergoing partial nephrectomy is unaffected by the intraoperative technique of identifying calyceal entry and the integrity of subsequent collecting system repair. Postoperative urine leaks are uncommon (6.6% in this series) despite recognized entry into the collecting system in the majority of patients (66%, 171 of 259). © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e582 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sammy Moussly TAMPA, FL More articles by this author Sandhya R. Rao TAMPA, FL More articles by this author Michelle Pacheco TAMPA, FL More articles by this author Philippe E. Spiess TAMPA, FL More articles by this author Wade J. Sexton TAMPA, FL More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...