Incidence and imaging appearance of urethrovesical anastomotic urinary leaks following da Vinci robotic prostatectomy

Abstract

The advent of the da Vinci robotic prostatectomy has several advantages over open and laparoscopic prostatectomy, including fewer complications, better continence and potency. We evaluate the incidence and imaging features of urinary leaks after robotic prostatectomy. A retrospective study examining the anastomotic leak rates from 490 consecutive robotic prostatectomy patients. Routine postoperative cystography on day 7 was reviewed for presence and severity of urinary anastomotic leaks. A total of 490 patients were reviewed, of which 442 had cystographic imaging postoperatively (n = 442). A total of 67 urinary leaks were identified; 40 were small, limited extraperitoneal leaks confined to the surgical bed, 21 were moderate sized leaks limited to the extraperitoneal pelvic space, and six extended in to the peritoneal cavity. Two of these six patients required CT-guided drainage for peritoneal urinoma. Other cystography findings included two cases of vesicoureteral reflux and one case of colovesical fistula. The incidence of postoperative anastomotic urinary leaks following robotic prostatectomy (13.6%) is the same or better than laparoscopic prostatectomy and traditional radical retropubic prostatectomy. The vast majority of urethrovesical leaks are transient, requiring no follow-up intervention. The incidence of large anastomotic leaks requiring CT guided intervention is exceedingly low 2/490 (<0.5%).