Identification and validation of risk factors for vesicourethral leaks following radical retropubic prostatectomy.
OBJECTIVE
To identify risk factors for anastomotic leaks at cystography following radical retropubic prostatectomy (RRP).


METHODS
In phase 1 the records of a 107 RRP patients were reviewed. Data collected included comorbidity, pathological factors and intra- and postoperative complications. From these, risk factors were identified that were associated with a leak at cystography. In phase 2 (n = 46) we prospectively tested if the risk factors identified could predict an anastomotic leak.


RESULTS
In phase 1 the only identifiable risk factors were that of a difficult anastamosis, an unsatisfactory intraoperative test flush and the presence of a urinary tract infection. One or more of these events were found in 17/25 (68%) of the patients who leaked (P < 0.0001). Of the eight leaks missed, five were classed as minimal and did not require repeat cystography. Within the prospective phase 2 cohort one or more risk factors were present in 7/10 (70%) of the patients who leaked. In contrast, the identified risk factors were present in only 5/36 (13.8%) of the patients who did not leak (P < 0.001). The specificity of the test was 86.1% with a sensitivity of 70%. This gave a positive predictive value of 58.3% and a negative predictive value of 91.1%. Three leaks (two minimal and one moderate) would have been missed but 31 (67.3%) patients would have avoided an unnecessary radiological study.


CONCLUSIONS
Using a retrospective and prospective cohort of patients we have shown that a cystogram following RRP can be safely avoided in the absence of the identified risk factors.
Gnanapragasam
Vincent J
VJ
Department of Urology and Radiology, James Cook University Hospital, Middlesbrough, UK. v.j.gnanapragasam@ncl.ac.uk
Baker
Paul
P
Naisby
Geoffrey P
GP
Chadwick
David
D
D000714:Anastomosis, Surgical / Q000009:adverse effects; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011468:Prostatectomy; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014521:Urethra / Q000601:surgery*; D001743:Urinary Bladder / Q000000981:diagnostic imaging* / Q000601:surgery*; D014552:Urinary Tract Infections / Q000150:complications