Postoperative drainage does not prevent complications after robotic partial nephrectomy.
OBJECTIVE
We aimed to assess the impact of a postoperative drainage after RPN.


METHODS
A retrospective multicentric study included RPN performed at eight centers between 2010 and 2014. Three centers stopped using postoperative drainage early in their RPN experience, whereas other institutions systematically left a drain. Preoperative characteristics, complication rates, need for postoperative imaging or procedure (surgical or radiological) and length of hospital stay were compared between the two groups [drainage (D) and no drainage (ND)].


RESULTS
Among 636 RPNs, 140 were done without drainage (22 %). In the ND group, surgeons were more experienced (>50 cases: 55.7 vs. 15.1 %; p < 0.0001), and tumors were more complex (RENAL score: 7.6 vs. 6.5; p < 0.0001). Complication rates were similar in both groups (21.9 vs. 20.2 %; p = 0.67). The omission of postoperative drainage did not increase requirement of CT scan (RR = 1.03; 95 % CI 0.64-1.67). Length of hospital stay was shorter in the ND group (4.5 vs. 5.5 days; p = 0.007). There were six urinary fistulas: four in the D group (0.8 %) and two in the ND group (1.4 %; p = 0.49). A CT scan was done to confirm the diagnosis of fistula in every case. In multivariate analysis, the omission of drainage was not associated with increased need of postoperative CT scan or major complications but was a predictor of decreased length of stay.


CONCLUSIONS
The omission of postoperative drainage does not seem to increase the risk of postoperative complications and could safely be omitted after RPN.
Department of Urology, University of Rennes, 2 rue Henri Le Guilloux, 35000, Rennes, France. peyronnetbenoit@hotmail.fr.
Benoit
B
Peyronnet
Department of Urology, University of Rennes, 2 rue Henri Le Guilloux, 35000, Rennes, France.|Department of Urology, University of Tours, Tours, France.
Benjamin
B
Pradère
Department of Urology, Henri-Mondor Hospital, Créteil, France.
Alexandre
A
De La Taille
Department of Urology, University of Tours, Tours, France.
Franck
F
Bruyère
Department of Urology, University of Toulouse, Toulouse, France.
Nicolas
N
Doumerc
Department of Urology, University of Nimes, Nimes, France.
Stéphane
S
Droupy
Department of Urology, La Pitié-Salpétrière Hospital, Paris, France.
Christophe
C
Vaessen
Department of Urology, Saint-Joseph Hospital, Paris, France.
Hervé
H
Baumert
Department of Urology, University of Bordeaux, Bordeaux, France.|French Research Network on Kidney Cancer (uroCCR), Bordeaux, France.
Jean-Christophe
JC
Bernhard
Department of Urology, La Pitié-Salpétrière Hospital, Paris, France.
Morgan
M
Rouprêt
Department of Urology, Georges Pompidou Hospital, Paris, France.
Arnaud
A
Mejean
Department of Urology, University of Rennes, 2 rue Henri Le Guilloux, 35000, Rennes, France.
Karim
K
Bensalah
D004322:Drainage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods*; D011182:Postoperative Care; D011183:Postoperative Complications / Q000209:etiology* / Q000517:prevention & control*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects*; D017211:Treatment Failure; D014548:Urinary Fistula / Q000209:etiology / Q000517:prevention & control / Q000628:therapy
Complications; Drain; Partial nephrectomy; Robotic; Urinary fistula