Impact of urethrovesical anastomotic leakage after robotic radical prostatectomy on early postoperative continence

ABSTRACT

Objective: This study aimed to assess the urethrovesical anastomotic leakage (UAL) and associated factors in patients who underwent robot-assisted radical prostatectomy (RARP) and its effect on early continence.

Material and Methods:  The data of 81 patients who underwent RARP between February 2017 and June 2022 were evaluated in this retrospective analysis. On the seventh postoperative day, we performed a cystography to determine whether the patients had UAL. Uni- and multivariate analyses were done to investigate the factors that could lead to UAL. Continence rates were recorded in patients at 6-12 weeks after surgery.

Results: Overall 25 patients (31%) had UAL; of them 12 (15%) were mild, eight (10%) were moderate, and five (6%) were extensive. A drain/serum creatinine ratio >1.5 and a prostate volume >53 cm³ were determined to be significant in predicting UAL in both the uni- and multivariate analyses (p=0.017 and p=0.046, respectively). On the postoperative second or third day, of the 36 patients who had drain output greater than 100 ml, eight (22%) had a high drain/serum creatinine ratio (>1.5), seven (88%) of which had UAL. According to the early period follow-up data, incontinence was prevalent in 9 (36%) of the patients with UAL and 20 (%37) of the patients without UAL (p=0.959).

Conclusion: Cystography is an effective method for detecting leakage after RARP. A large prostate volume (>53 cm³) and a high postoperative drain/serum creatinine ratio (>1.5) were found to be associated with UAL. UAL had no effect on early continence.

Keywords: anastomotic leak, cystography, prostatectomy, robot-assisted, urinary incontinence

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ABSTRACT

Objective: This study aimed to assess the urethrovesical anastomotic leakage (UAL) and associated factors in patients who underwent robot-assisted radical prostatectomy (RARP) and its effect on early continence.

Material and Methods:  The data of 81 patients who underwent RARP between February 2017 and June 2022 were evaluated in this retrospective analysis. On the seventh postoperative day, we performed a cystography to determine whether the patients had UAL. Uni- and multivariate analyses were done to investigate the factors that could lead to UAL. Continence rates were recorded in patients at 6-12 weeks after surgery.

Results: Overall 25 patients (31%) had UAL; of them 12 (15%) were mild, eight (10%) were moderate, and five (6%) were extensive. A drain/serum creatinine ratio >1.5 and a prostate volume >53 cm³ were determined to be significant in predicting UAL in both the uni- and multivariate analyses (p=0.017 and p=0.046, respectively). On the postoperative second or third day, of the 36 patients who had drain output greater than 100 ml, eight (22%) had a high drain/serum creatinine ratio (>1.5), seven (88%) of which had UAL. According to the early period follow-up data, incontinence was prevalent in 9 (36%) of the patients with UAL and 20 (%37) of the patients without UAL (p=0.959).

Conclusion: Cystography is an effective method for detecting leakage after RARP. A large prostate volume (>53 cm³) and a high postoperative drain/serum creatinine ratio (>1.5) were found to be associated with UAL. UAL had no effect on early continence.

Keywords: anastomotic leak, cystography, prostatectomy, robot-assisted, urinary incontinence

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