title: Clinical pathway after robotic nephroureterectomy: omission of pelvic drain with next-day catheter removal and discharge.
abstract: OBJECTIVE
  To determine the feasibility of applying a postoperative clinical pathway after robotic nephroureterectomy (RNU) targeting safe omission of a pelvic drain and removal of the bladder catheter on the day after surgery with hospital discharge on postoperative day 1 (POD#1).
  
  
  METHODS
  We reviewed a prospectively collected database of all RNUs performed by a single surgeon (R.A.) since institution of our clinical pathway in 2008 that includes pelvic drain omission, bladder catheter removal the morning after surgery, and discharge on POD#1. Patient demographics, and perioperative and postoperative outcomes were evaluated. Ability to adhere to the pathway and achieving the described parameters and whether any resulting complications occurred were determined.
  
  
  RESULTS
  RNU was performed in 29 patients with mean age and body mass index of 69 years (50-90 years) and 30 kg/m(2) (19-41 kg/m(2)), respectively. No patient required a pelvic drain, and 2 were discharged with a catheter. All but 2 patients (93%) were discharged on POD#1. Overall, successful pathway application was achieved in 26 of 29 patients (90%) including no drain, catheter removal on the morning after surgery, and discharge on POD#1. No patient developed urine leak or other complications related to early catheter removal.
  
  
  CONCLUSIONS
  Our clinical pathway after RNU allows safe omission of a pelvic drain with early discontinuation of the bladder catheter and discharge on the POD#1 in most patients. To our knowledge, similar pathways have not been previously achieved with nephroureterectomy by any approach, but should be considered by surgeons treating urothelial carcinoma of the upper urinary tract.
authors: Department of Urology, The Ohio State University Wexner Medical Center & James Cancer Hospital, Columbus, OH. Electronic address: Tariq.Khemees@osumc.edu.
authors: Tariq A
authors: TA
authors: Khemees
authors: Department of Urology, The Ohio State University Wexner Medical Center & James Cancer Hospital, Columbus, OH.
authors: Samiha M
authors: SM
authors: Nasser
authors: Department of Urology, The Ohio State University Wexner Medical Center & James Cancer Hospital, Columbus, OH.
authors: Ronney
authors: R
authors: Abaza
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019091:Critical Pathways; D020878:Device Removal; D004322:Drainage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D010351:Patient Discharge; D011184:Postoperative Period; D011446:Prospective Studies; D012371:Robotics; D013997:Time Factors; D016896:Treatment Outcome; D014546:Urinary Catheterization / Q000379:methods; D013520:Urologic Surgical Procedures / Q000379:methods*