title: The Watertightness of the Anastomosis After Laparoscopic or Robot-Assisted Pyeloplasty: Is a Drainage Necessary?
abstract: To determine whether or not temporary drainage is necessary immediately following laparoscopic (lap) and robot-assisted (rob) pyeloplasty (PP).
  
  
  
  Of 99 patients undergoing lap PP (n = 23) or rob PP (n = 76) for treatment of ureteropelvic junction obstruction (UPJO), 52 had no drainage, 47 were given an "easy-flow" drain (EFD). The volume of leaking urine (in mL) was defined as the volume of drainage fluid (in mL) × creatinine concentration in drainage fluid (in μmol/mL)/median urine creatinine concentration (in μmol/mL). An anastomosis was considered to be leaking if the volume of leaking urine exceeded 5 mL/24 hours. During follow-up the PP success rate was evaluated based on clinical symptoms, intravenous urography and diuretic renography for detection of persisting obstruction.
  
  
  
  Median creatinine concentration in drainage fluid was 90 μmol/L (range 44-6270 μmol/L) in a median volume of 84 mL (range 5-1400 mL) drained fluid in 24 hours. The median leaking urine volume was 1.18 mL (range 0.07-291.34 mL), a leaking anastomosis was diagnosed in 5/47 (11%) patients. In patients with EFD and without EFD, complications occurred in 15% and 8% (p = 0.342), respectively, with success rates of 98% and 100% (p = 0.475). Complications (Clavien I-III) occurred in 4/42 (9.5%) patients with watertight and in 3/5 (60%) patients with leaking anastomosis (p = 0.019). No statistically significant differences were noted between lap PP and rob PP patients regarding complication and success rates.
  
  
  
  Lap PP and rob PP were primary watertight in 89% of all patients. A primary leaking anastomosis had no influence on PP outcome, but was associated with a higher risk of complications. However, neither the success rate nor the complication rate differed between drained and undrained patients. We conclude, therefore, that drainage is not necessary.
authors.affiliation: Klinik für Urologie, Luzerner Kantonsspital , Lucerne, Switzerland .
authors.forename: Annika
authors.initials: A
authors.lastname: Rühle
authors.affiliation: Klinik für Urologie, Luzerner Kantonsspital , Lucerne, Switzerland .
authors.forename: Emilio
authors.initials: E
authors.lastname: Arbelaez
authors.affiliation: Klinik für Urologie, Luzerner Kantonsspital , Lucerne, Switzerland .
authors.forename: Agostino
authors.initials: A
authors.lastname: Mattei
authors.affiliation: Klinik für Urologie, Luzerner Kantonsspital , Lucerne, Switzerland .
authors.forename: Hansjoerg
authors.initials: H
authors.lastname: Danuser
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000592:standards*; D057868:Anastomotic Leak / Q000209:etiology*; D003404:Creatinine / Q000652:urine; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D007682:Kidney Pelvis / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D065287:Robotic Surgical Procedures / Q000379:methods*; D014513:Ureter / Q000601:surgery*; D014517:Ureteral Obstruction / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods; D055815:Young Adult
chemical_list: D003404:Creatinine
keywords: anastomosis watertightness; laparoscopic and robot-assisted pyeloplasty; ureteropelvic junction obstruction; wound drainage