Abstract
BackgroundIntraoperative urinary collecting system entry (CSE) in robot-assisted partial nephrectomy (RAPN) may cause postoperative urinary leakage and extend the hospitalization. Therefore, identifying and firmly closing the entry sites are important for preventing postoperative urine leakage. In RAPN cases expected to require CSE, we insert a ureteral catheter and inject dye into the renal pelvis to identify the entry sites. We retrospectively analyzed the factors associated with intraoperative CSE in RAPN and explored the indications of intraoperative ureteral catheter indwelling in RAPN.MethodsOf 104 Japanese patients who underwent RAPN at our institution from August 2016 to March 2020, 101 were analyzed. The patients were classified into CSE and non-CSE groups. The patients’ background characteristics, RENAL Nephrometry Score (RNS), and surgical outcomes were analyzed.ResultsIntraoperative CSE was observed in 41 patients (41%). The CSE group had a significantly longer operative time, console time, ischemic time, and hospital stay than the non-CSE group. In a multivariable analysis, the N-score (odds ratio [OR] = 3.9, P < 0.05) and RNS total score excluding the L-score (OR = 3.1, P < 0.05) were associated with CSE. In a logistic regression analysis, CSE showed a moderate correlation with the RNS total score excluding the L-score (AUC 0.848, cut-off 5, sensitivity 0.83, specificity 0.73).ConclusionA ureteral catheter should not be placed in patients with an RNS total score (excluding the L-score) of ≤ 4.
Highlights
Partial nephrectomy for renal cell carcinoma is a standard treatment that can be expected to preserve the renal function while maintaining cancer control, but it carries more complications than radical nephrectomy
In the logistic regression analysis, collecting system entry (CSE) showed a moderate correlation with the RENAL Nephrometry Score (RNS) total score excluding the L-score (AUC 0.848, cut-off 5, sensitivity 0.83, specificity 0.73) (Fig. 1)
We evaluated the relationship between CSE and RNS in 101 cases of robot-assisted partial nephrectomy (RAPN) in the present study and found significant differences between the two groups regarding the R-score, E-score, N-score, RNS total score, and RNS total score excluding the Lscore
Summary
Partial nephrectomy for renal cell carcinoma is a standard treatment that can be expected to preserve the renal function while maintaining cancer control, but it carries more complications than radical nephrectomy. Once postoperative urine leakage is found, invasive treatment, such as placing a ureteral catheter or surgical intervention, is required for management. Postoperative urine leakage is caused mainly by insufficient closure of intraoperative collecting system entry (CSE) [3]. One way to identify entry sites is via visual recognition of dye in the renal pelvis with the insertion of a ureteral catheter during dissection of a renal tumor [4, 5]. Intraoperative urinary collecting system entry (CSE) in robot-assisted partial nephrectomy (RAPN) may cause postoperative urinary leakage and extend the hospitalization. Identifying and firmly closing the entry sites are important for preventing postoperative urine leakage. In RAPN cases expected to require CSE, we insert a ureteral catheter and inject dye into the renal pelvis to identify the entry sites.
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