What is the long‐term relevance of clinically detected postoperative anastomotic urine leakage after robotic‐assisted laparoscopic prostatectomy?

Abstract

Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? The use of a drain to detect and evacuate anastomotic urine leakage after radical prostatectomy is a common clinical practice. The use of such drains, traditionally, attempts to avoid the short‐term risks of urinoma, ileus, and infection, but little is known on the long‐term complications of such leakage on functional outcomes, such as erectile function, continence, and bladder neck contracture. This study shows that after a mean of two years of follow‐up, patients with clinically detected anastomotic urine leakage after robotic‐assisted laparoscopic radical prostatectomy do not have worse erectile function, incontinence or risk of bladder neck contracture than patients who had no clinical evidence of leakage. OBJECTIVE • To determine whether patients with postoperative clinically detected anastomotic urine leaks are at increased risk for poorer erectile function, urinary incontinence and bladder neck contracture (BNC) after robotic‐assisted laparoscopic radical prostatectomy. PATIENTS AND METHODS • A retrospective review of all patients undergoing RALRP from October 2005 until December 2009 by a single surgeon (R.B.N.) was conducted. Clinically detected anastomotic urine leak was defined as drain output consistent with urine at more than 24 h postoperatively. The presence of BNC was identified on cystoscopy. • Erectile function was measured with the Sexual Healthy Inventory for Men (SHIM) questionnaire. Incontinence was measured by patient‐reported daily pad use. • Univariate and multivariate analyses were performed. Outcomes were assessed at the most recent follow‐up. RESULTS • Among 213 patients eligible for inclusion, 27 experienced an anastomotic urine leak (12.7%). • At a mean long‐term follow‐up of 24.2 months, there was no difference in SHIM scores (7.0 vs 13.1; P = 0.101), continence rates (87.5% vs 85.2%; P = 0.999) or risk of BNC (7.4% vs 3.2%; P = 0.268) between patients with and without postoperative anastomotic urine leaks, respectively. • The results did not change after controlling for covariates in a multivariate analysis. CONCLUSION • The present study suggests that patients with clinically detected postoperative anastomotic urine leaks do not necessarily have worse long‐term outcomes of erectile function, continence and risk of BNC.