title: What is the long-term relevance of clinically detected postoperative anastomotic urine leakage after robotic-assisted laparoscopic prostatectomy?
abstract: 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.
  
  
  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.
  
  
  CONCLUSIONS
  • 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.
authors.affiliation: Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Rebuck
authors.forename: Samuel
authors.initials: S
authors.lastname: Haywood
authors.forename: Kelly
authors.initials: K
authors.lastname: McDermott
authors.forename: Kent T
authors.initials: KT
authors.lastname: Perry
authors.forename: Robert B
authors.initials: RB
authors.lastname: Nadler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D004322:Drainage / Q000379:methods; D007172:Erectile Dysfunction / Q000209:etiology*; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods; D011471:Prostatic Neoplasms / Q000601:surgery*; D012371:Robotics; D013997:Time Factors; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000209:etiology*