Pelvic Drainage Research Articles

A Pelvic Drain Can Often Be Avoided After Radical Retropubic Prostatectomy—An Update in 552 Cases

ObjectivesThe routine placement of a pelvic drain following radical retropubic prostatectomy (RRP) may not be required. We describe our experience in 552 consecutive RRPs to emphasise the safety of this approach and explain our rationale for avoiding a drain when possible. MethodsRRP was performed in 552 consecutive patients with clinically localised adenocarcinoma of the prostate between January 2002 and June 2005. Clinical and pathologic information was documented for each patient. After the prostate was removed and the anastomotic sutures tied, the bladder was gently filled with approximately 50 ml of saline through the urethral catheter. If there was no leak, a drain was not placed. ResultsA drain was not placed in 419 (76%) of the 552 patients. We compared the postoperative complication rates in those with (D+) and without (D−) a drain. There were 27 (5%) immediate postoperative complications and no significant difference between the two groups (D+, 6%; D−, 5%; p=0.629): three (1%) patients who did not have a drain had a urinoma, one (1%) who had a drain had a lymphocele, and two (2%) who had a drain had a small pelvic haematoma. ConclusionsIf the bladder neck is preserved or meticulously reconstructed, there may be little extravasation and, thus, routine drainage is unnecessary. Our 4-year experience indicates that morbidity is not increased by omitting a drain from the pelvic cavity after RRP in properly selected cases.

Open Dismembered Tubularized Flap Pyeloplasty: An Effective and Simple Operation for Treatment of Ureteropelvic Junction Obstruction

Objective: To evaluate the success rate of dismembered tubularized flap pyeloplasty (DTFP) in the treatment of ureteropelvic junction obstruction (UPJO). Patients and Methods: In a prospective study from August 2002 to September 2004, 15 patients with a mean age of 21 years (range 2–47) in whom UPJO had been diagnosed by sonography, excretory urography or diuretic renography and who had a large extrarenal pelvis, underwent operation via flank intercostal incision. The proximal ureter and renal pelvis were dissected and mobilized retroperitoneally, the site of UPJO was excised and the site of insertion of the ureter on the renal pelvis was closed with a stitch. A wide based renal pelvic flap was created and tubularized to bridge the upper ureteral defect. After insertion of a nephrostomy tube, a double-J tube was inserted as an internal ureteral stent and anastomosis of the tubularized flap to the spatulated upper ureter was done and the renal pelvis window was closed. Patients were followed 3, 6 and 12 months postoperatively. Results: Mean operation time was 1 h and mean hospital stay was 3 days. The ureteral stent was removed 4 weeks after operation and at the same time a nephrostogram was done that showed a widely patent ureteropelvic junction with good renal pelvis drainage in 12 (∼80%) of the cases, but in 3 cases (∼20%) passage of contrast materials was not seen. In these patients, methylene blue was injected via a nephrostomy tube and in 2 patients (14%) urine color turned blue 20 min later, but in 1 patient (7%) this test was also negative. The latter patient underwent percutaneous endopyelotomy later. Mean patient follow-up was 14 months. Follow-up excretory urography confirmed patent and unobstructed ureteropelvic junction in all patients. The overall success rate of DTFP was 93%. Conclusion: DTFP is a simple and effective procedure for patients with UPJO who have long or multiple upper ureteral strictures and a large extrarenal pelvis.

Drenaż miednicy mniejszej w operacjach ginekologicznych - opis przypadku

Drenaż miednicy mniejszej w operacjach ginekologicznych - opis przypadku

Pelvic Drainage and Other Risk Factors for Leakage After Anterior Resection in Rectal Cancer Patients

Pelvic Drainage and Other Risk Factors for Leakage After Anterior Resection in Rectal Cancer Patients

Pelvic Drainage and Other Risk Factors for Leakage After Anterior Resection in Rectal Cancer Patients

Pelvic Drainage and Other Risk Factors for Leakage After Anterior Resection in Rectal Cancer Patients

An unusual case of incisional hernia

An incisional hernia is one that develops in the scar of a surgical incision. There is a risk of strangulation with a narrow neck and large sac. Thin walled hernias may ulcerate and develop intestinal fistula. The long-term incidence in best centers is 10%. Predisposing factors are obesity, age, wound infection and incisions more than 18cms. Common contents are omentum, transverse colon, loops of small bowel and stomach [1]. Although gravid uterus in an incisionsal hernia has been reported earlier[2], the occurrence of incisional hernia 25 years after laparotomy with a pedunculated fibroid uterus as its content is extremely rare (Fig 1). Fig. 1 Incisional hernia (optd) – uterus (left), tumour (right) Case Report Fifty six year old mother of a serving soldier presented with pain and swelling of lower abdomen since six years, increasing in size in last six months. She was also an old case of bronchial asthma over previous ten years and had last child birth in 1970 with twins delivered by Lower Segment Caesarian Section (LSCS). After LSCS she was asymptomatic till 1996 when she noticed a small lump which remained static for six years and started increasing in size over the previous six months. On examination her general condition was good, vitals normal, lungs clear, abdomen soft, swelling in lower abdomen more to right of mid-line, size 20×15cm, not completely reducible, transillumination negative and cough impulse present. A 3 × 2cm gap was felt in linea alba in infra umbilical region on asking the patient to raise her leg or neck in supine position without support of arms. She was diagnosed as a case of irreducible incisional hernia with omentum as its content. Under spinal anaesthesia converted to general anaesthesia, through an infra umbilical incision the sac was defined, opened, uterus was found lying outside the sac with a kidney shaped 12 × 8cm fleshy growth attached to it. Adhesions with parietal peritoneum were released. Bladder was catheterized, dissected free from uterus, planes defined and subtotal hysterectomy with bilateral salpingo-oophrectomy was done. Extra margins of sac with extra-peritoned fat were excised. Rectus shealth and linea alba on each side were dissected and resutured using 1/o prolene with reconstruction of linea alba in two layers. Wound was closed leaving a parietal and pelvic drain. Post operatively the patient made an uneventful recovery. She was discharged on the 13th post op day and has been followed up for 6 months with no recurrence.

Risk factors for anastomotic failure after total mesorectal excision of rectal cancer

Anastomotic leakage is a major complication of rectal cancer surgery. The aim of this study was to investigate risk factors associated with symptomatic anastomotic leakage after total mesorectal excision (TME). Between 1996 and 1999, patients with operable rectal cancer were randomized to receive short-term radiotherapy followed by TME or to undergo TME alone. Eligible Dutch patients who underwent an anterior resection (924 patients) were studied retrospectively. Symptomatic anastomotic leakage occurred in 107 patients (11.6 per cent). Pelvic drainage and the use of a defunctioning stoma were significantly associated with a lower anastomotic failure rate. A significant correlation between the absence of a stoma and anastomotic dehiscence was observed in both men and women, for both distal and proximal rectal tumours. In patients with anastomotic failure, the presence of pelvic drains and a covering stoma were both related to a lower requirement for surgical reintervention. Placement of one or more pelvic drains after TME may limit the consequences of anastomotic failure. The clinical decision to construct a defunctioning stoma is supported by this study.

Reducing blood loss at open myomectomy using triple tourniquets: A randomised controlled trial

To evaluate triple tourniquets in controlled conditions and for the first time to investigate the hypothesis that leaving a semi-permanent tourniquet around the uterine artery reduces post-operative bleeding from the uterine incisions. A randomised controlled trial. Two University teaching hospitals. Twenty-eight patients with symptomatic fibroids and uterine sizes ranging from 14 to 24 weeks of gestation undergoing open myomectomy. A number 1 polyglactin suture was tied around the cervix to occlude the uterine arteries, and polythene tourniquets were tied around the infundibulopelvic ligament to obstruct the ovarian vessels. At the end of the procedure, the ovarian ties were released but the uterine artery suture remained in situ. Intra-operative blood loss, post-operative blood loss, blood transfusion rates, operative morbidity, uterine blood flow and ovarian function. There was significantly less blood lost in the tourniquet group than in the control group (difference between means 1870 mL, 95% CI 1159-2580 mL, P < 0.0001; transfusion rates of 7% and 79%, P= 0.0003). The volume in the pelvic drain 20 min post-operatively and after 48 hours failed to reach statistical significance between the two groups (P= 0.10 and P= 0.165). There were no differences in uterine artery Doppler resistance indices at five days (P= 0.54), six weeks (P= 0.47), three months (P= 0.49) and at six months (P= 0.18). Day two serum FSH concentrations after surgery were unchanged (P= 0.45), compared with baseline values. Triple tourniquets are effective in reducing bleeding and transfusion rates. There appears no obvious adverse effect on uterine perfusion or ovarian function.

Pelvic Drainage and Other Risk Factors for Leakage After Elective Anterior Resection in Rectal Cancer Patients

The objective of this study was to investigate prophylactic pelvic drainage and other factors that might be associated with anastomotic leakage after elective anterior resection of primary rectal cancer. Anastomotic leak after anterior resection for primary rectal cancer leads to significant postoperative morbidity and mortality. The role of pelvic drainage in the prevention of anastomotic leakage is controversial. We investigated 978 consecutive patients undergoing elective anterior resection for primary rectal cancer between February 1995 and December 1998 in a single institution. Use of a drain and type of drainage were at the surgeon's preference. Data were prospectively collected during hospitalization. Twenty-five independent tumor-, patient-, and treatment-related variables were analyzed. The dependent variable was clinical anastomotic leakage. A binary logistic regression analysis was used to assess the independent association of variables with the dependent variable. The clinical anastomotic leakage rate was 2.8%. Independent risk factors for anastomotic leakage were use of an irrigation-suction drain (odds ratio [OR], 9.13; 95% confidence interval [CI], 1.16-71.76), blood transfusion, poor colon preparation (OR, 2.58; 95% CI, 1.10-5.88), and anastomotic level 5 cm or less from the anal verge (OR, 2.38; 95% CI, 1.03-5.46). Routine use of pelvic drainage is not justified and should be discouraged. In cases in which pelvic drainage is required such as in difficult operations or to prevent pelvic hematoma, pelvic drainage other than irrigation-suction should be considered.

Postoperative leakage and abscess formation after colorectal surgery

Anastomotic leaks following colorectal surgery may be divided into those which are clinically significant and those which are not. Leakage occurs in 3.4-6% of all colorectal cases. It is most commonly associated with rectal anastomoses, being clinically significant in 2.9-15.3% of cases. Mortality following a leak may be 6.0-39.3%. There is no evidence that preoperative bowel preparation reduces the rate and consequences of leaks. There is no evidence for the use of drains when an anastomosis has been made outside the pelvis, but pelvic drainage may be important after anterior resection. The use of covering stomas has not been shown to reduce leak rate but does mitigate the clinical effects of leaks. Prompt diagnosis and further laparotomy can reduce mortality following leakage. Intra-abdominal abscesses can in most cases be treated by radiologically guided drainage. Anastomotic leaks are the most common cause of anastomotic strictures and are also associated with increased rates of local recurrence of cancer.

834: The Continuous Suture Allows for Early Catheter Removal without Pelvic Drainage, and May be the Preferred Technique of Vesicourethral Anastomosis in RRP

You have accessJournal of UrologyDiscussed Poster, Monday, May 10, 2004, 8:00am - 12:00 pm1 Apr 2004834: The Continuous Suture Allows for Early Catheter Removal without Pelvic Drainage, and May be the Preferred Technique of Vesicourethral Anastomosis in RRP Aloysio F. De Toledo, Gustavo F. Carvalhal, Jorge Noronha, and Henrique S. Barata Aloysio F. De ToledoAloysio F. De Toledo More articles by this author , Gustavo F. CarvalhalGustavo F. Carvalhal More articles by this author , Jorge NoronhaJorge Noronha More articles by this author , and Henrique S. BarataHenrique S. Barata More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)38083-2AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "834: The Continuous Suture Allows for Early Catheter Removal without Pelvic Drainage, and May be the Preferred Technique of Vesicourethral Anastomosis in RRP." The Journal of Urology, 171(4S), p. 220 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 171Issue 4SApril 2004Page: 220 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Aloysio F. De Toledo More articles by this author Gustavo F. Carvalhal More articles by this author Jorge Noronha More articles by this author Henrique S. Barata More articles by this author Expand All Advertisement PDF downloadLoading ...

Dynamic Renal Scintigraphy in Children With Vesicoureteral Reflux and Suspected Coexisting Ureteropelvic Junction Obstruction

We evaluated whether findings on voiding cystourethrography suggesting ureteropelvic junction (UPJ) obstruction coexists with vesicoureteral reflux (VUR) are associated with parameters on dynamic renal scintigraphy that support significant obstruction. We reviewed records of 44 patients referred for scintigraphy after voiding cystourethrography performed at age 1 day to 9.4 years (mean 7 months, median 1.7 months) showed VUR and findings suggestive of UPJ obstruction (blockage of contrast material at the UPJ, contrast dilution in the renal pelvis, slow renal pelvic drainage). Results were correlated with Society for Fetal Urology hydronephrosis grade and ureteral morphology. Halftime was in the obstructive range (20 minutes or greater) for 7 of 47 kidneys (15%). The prevalence of a post-furosemide pelvicaliceal drainage halftime in the obstructive range increased with hydronephrosis grade (0% grade 1, 17% grade 2, 50% grade 3 to 4, p = 0.002) but did not vary with ureteral morphology (p = 0.08). In 12 of 38 cases (31%) where suspected UPJ obstruction was unilateral and a contralateral kidney was present differential uptake of the affected kidney was less than 45%. The prevalence of differential uptake less than 45% was higher in patients with than without ureteral dilatation (48% vs 12%, p = 0.02) but did not vary with hydronephrosis grade (p = 0.93). In children with VUR and suspected coexisting UPJ obstruction dynamic renal scintigraphy may support significant obstruction when hydronephrosis is at least moderate in degree or ureteral dilatation is present but is unlikely to do so if neither is observed.

A Pelvic Drain May be Avoided After Radical Retropubic Prostatectomy

We reassessed the role of routine pelvic cavity drainage to prevent complications after radical retropubic prostatectomy (RRP). RRP was performed in 116 consecutive patients with clinically localized adenocarcinoma of the prostate. Clinical and pathological information was recorded for each patient. After the prostate was removed and the anastomotic sutures were tied the bladder was filled with saline through the urethral catheter. If there was no significant leakage, a drain was not placed. We did not place a drain in 85 of the 116 patients (73%). There were 3 immediate postoperative complications. In a patient without a drain, a urinoma developed that required percutaneous placement of a drain on postoperative day 2. None of the 116 patients had clinical evidence of infection, lymphocele or hematoma. Two patients had hematuria 2 weeks after catheter removal and needed bladder irrigation. Neither patient had a drain. Three patients (drain and no drain in 1 each) were in urinary retention after catheter removal, which required catheter reinsertion for an additional week. None had an anastomotic stricture. The morbidity of RRP is low when performed by those who regularly perform this procedure. If the bladder neck is preserved or meticulously reconstructed, there may be little or no extravasation and, thus, routine drainage may be unnecessary. In properly selected cases morbidity is not increased by omitting a drain from the pelvic cavity after RRP.

Post-prostatectomy Bleeding Managed by Endovascular Embolization

Prostate cancer is the second most common cause of cancer related mortality in males in the United States. Radical prostatectomy is a common treatment for localized prostate cancer. Significant post-prostatectomy hemorrhage is a rare but serious complication, occurring in less than 0.5% of cases.1 Treatment options include surgical exploration with ligation of bleeding sites, observation with ultimate tamponade and endovascular control. Intraoperative internal iliac artery ligation has previously been recommended to decrease blood loss.2 However, postoperative endovascular control is another option.3 We report the results of this approach in a patient with postoperative bleeding from the artery to the seminal vesicle. CASE REPORT A 70-year-old man with Gleason score 4 3, prostate specific antigen 4.7 ng./ml., T2a prostate cancer underwent uneventful nerve sparing radical retropubic prostatectomy and pelvic lymphadenectomy. Estimated blood loss was 900 cc. The following morning the patient complained of pelvic pain, and hemoglobin and hematocrit were 7.4 gm./dl. (normal 13.5 to 17.5) and 21.5% (normal 41% to 53%), respectively. There was minimal output from the pelvic drain. Two units of blood were transfused, and computerized tomography of the abdomen and pelvis demonstrated a large

Percutaneous Abdominal and Pelvic Abscess Drainage Techniques. Part II: Imaging Guidance, Catheter Insertion Techniques, and Access to Difficult Locations

Percutaneous Abdominal and Pelvic Abscess Drainage Techniques. Part II: Imaging Guidance, Catheter Insertion Techniques, and Access to Difficult Locations

Percutaneous Abdominal and Pelvic Abscess Drainage Techniques-Part I: Tools of the Trade

This review is a pictorial essay discussing the tools used in the image-guided percutaneous drainage of abdominal and pelvic abscesses. Topics covered include drainage catheters, access devices, directional catheters, dilators and sheaths, localizing devices, and fixation devices and drainage systems.

Complications after stapled hemorrhoidectomy: can they be prevented?

Stapled hemorrhoidectomy (SH), a new approach to the treatment of hemorrhoids, removes a circumferential strip of mucosa about four centimeters above the dentate line. A review of 1,107 patients treated with SH from twelve Italian coloproctological centers has revealed a 15% (164/1,107) complication rate. Immediate complications (first week) were: severe pain in 5.0% of all patients, bleeding (4.2%), thrombosis (2.3%), urinary retention (1.5%), anastomotic dehiscence (0.5%), fissure (0.2%), perineal intramural hematoma (0.1%), and submucosal abscess (0.1%). Bleeding was treated surgically in 24%, with Foley insertion 15%; and by epinephrine infiltration in 2%; 53% of patients with bleeding received no treatment and 6% needed transfusion. One patient with anastomotic dehiscence needed pelvic drainage and colostomy formation. The most common complication after 1 week was recurrence of hemorrhoids in 2.3% of patients, severe pain (1.7%), stenosis (0.8%), fissure (0.6%), bleeding (0.5%), skin tag (0.5%), thrombosis (0.4%), papillary hypertrophy (0.3%) fecal urency (0.2%), staples problems (0.2%), gas flatus and fecal incontinence (0.2%), intramural abscess, partial dehiscence, mucosal septum and intussusception (each <0.1%). Recurrent hemorrhoids were treated by ligation in 40% and by Milligan-Morgan procedure in 32%. All hemorrhoidal thromboses were excised. Anal stenoses were treated by dilatation in 55% and by anoplasty in 45%. Fissure was treated by dilatation in 57%. Most complications (65%) occurred after the surgeon had more than 25 case experiences of stapled hemorrhoidectomy. The most common complication in the first 25 cases of the surgeon's experience was bleeding (48%). Even though SH appears to be promising, we feel that a multicenter randomized study with a long-term follow-up comparing SH and banding is necessary before recommending the procedure. Most complications can be avoided by respecting the rectal wall anatomy in the execution of the procedure.

Drain-Free Simple Retropubic Prostatectomy With Fibrin Sealant

We present our preliminary experience with liquid fibrin sealant during simple retropubic prostatectomy. We reviewed 18 consecutive simple retropubic prostatectomies performed for symptomatic advanced benign prostatic hyperplasia at our institution between 1997 and 2001. Adenoma enucleation was performed via transverse anterior prostatic capsulotomy. In the first 13 cases (group 1) a Jackson-Pratt suction drain was placed in the pelvis after prostatic capsular closure. In the remaining 5 cases (group 2) 2 ml. liquid fibrin sealant were administered over the closed prostatic capsule instead of a pelvic drain. The 2 groups were matched for age and prostate size. Average time to drain removal in control group was 3.92 days, while the fibrin sealant group had no clinically apparent adverse sequelae despite the lack of pelvic drainage. Average hospitalization in group 1 was 4.38 days, while all group 2 patients were discharged home after 2 days (p = 0.001). In addition, a trend toward earlier resumption of a full diet was noted in the sealant group (2.61 versus 1 day, p = 0.075). Liquid fibrin sealant appears to expedite recovery and shorten hospitalization when used as an adjunct during simple prostatectomy.

Percutaneous Abdominal and Pelvic Abscess Drainage in Children - A Practical Approach

Percutaneous Abdominal and Pelvic Abscess Drainage in Children - A Practical Approach

Early removal of urinary catheter after radical retropubic prostatectomy is both feasible and desirable

Objectives. To determine the feasibility and desirability of removing the urinary catheter 7 days after radical retropubic prostatectomy. Methods. Between February 28, 2000 and October 5, 2000, 184 men underwent radical retropubic prostatectomy by a single surgeon. Of these men, 97% underwent gravity cystography under fluoroscopic control on postoperative day (POD) 7. The indwelling urinary catheter was removed on POD 7 if no evidence of extravasation was observed on cystography. Patients completed a self-administered questionnaire at the time of catheter removal to capture the degree of bother from incisional pain and the indwelling urinary catheter during the recovery period. The level of urinary continence was determined at 3 months after radical retropubic prostatectomy. Results. One hundred thirty-five of the cystograms (75%) had no evidence of extravasation. The indwelling catheters were removed in 130 (97%) of 135 cases. The body weight, surgical specimen weight, presence or absence of intraoperative anastomotic extravasation, volume of pelvic drainage recorded from the Hemovac drain, and creatinine level of the pelvic drainage fluids did not predict the finding of extravasation on the POD 7 cystogram. Fifteen percent of the men whose catheters were removed on POD 7 developed acute urinary retention. At 3 months, 72% of men required no or a single protective pad, and 87% indicated they experienced no or slight bother from incontinence. These continence outcomes are comparable with a historical control group by the same surgeon who underwent catheter removal on POD 14. Forty-five percent of the men reported the catheter caused moderate to severe bother, compared with only 19% of men who indicated moderate to severe bother from incisional pain. In retrospect, 95.6% of men indicated willingness to undergo cystography on POD 7 with the intent of early catheter removal. Conclusions. The results of our study suggest that most men will have no extravasation on a cystogram performed on POD 7 and that removing the catheter at this time in these cases does not increase the risk of complications or compromise overall urinary continence. The urinary catheter is a significant bother and limits physical activity during the postoperative period. Cystography and early removal of the catheter is both feasible and desirable and should be offered to men after radical retropubic prostatectomy.