Evaluating and grading cystographic leakage: correlation with clinical outcomes in patients undergoing robotic prostatectomy.
OBJECTIVE
To classify cystographically detected urinary leaks in patients undergoing computer-assisted (robotic) radical prostatectomy (RP) and to evaluate its effect on postoperative outcomes.


METHODS
Between October 2001 and October 2007, 3327 patients had a RP using a technique described previously. The data were entered prospectively into an approved database. Before catheter removal, all patients had a gravity cystogram taken 7 days after RP. All patients who had a detectable urinary leak on cystography were stratified into three groups by two independent radiologists using a previously described grading system. Patients were evaluated with a validated International Prostate Symptom Score at 3-, 6-, 9- and 12-month intervals after RP. The continence status was determined based on a patient-reported questionnaire. Medical records in these patients were reviewed for the presence of complications requiring secondary interventions.


RESULTS
In all, 287 patients (8.6%) had a detectable leak on cystography, of which 179 (62.4%), 84 (29.3%) and 24 (8.4%) were grades I, II and III, respectively. Of the patients with a detectable leak 70% were continent within 3 months and 94% had no involuntary urinary leakage at 1 year. Eight of 287 (2.8%) patients required a secondary intervention to correct bladder neck contracture. All eight of these patients had a grade II or III leak on cystography.


CONCLUSIONS
The presence of a urinary leak might delay the time to continence, but has no adverse effect on long-term urinary control. Quantifying the gradation of leakage according to the described classification might provide the clinician with prognostic information about patients at risk for future interventions.
Patil
Nilesh
N
Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI 48202, USA. npatil1@hfhs.org
Krane
Louis
L
Javed
Khurram
K
Williams
Todd
T
Bhandari
Mahendra
M
Menon
Mani
M
D000328:Adult; D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods; D011471:Prostatic Neoplasms / Q000150:complications / Q000601:surgery*; D012371:Robotics; D016896:Treatment Outcome; D014546:Urinary Catheterization / Q000009:adverse effects; D014549:Urinary Incontinence / Q000209:etiology / Q000473:pathology*