Evaluating and grading cystographic leakage: correlation with clinical outcomes in patients undergoing robotic prostatectomy
Article first published online: 18 NOV 2008
© 2008 THE AUTHORS. JOURNAL COMPILATION © 2008 BJU INTERNATIONAL
Volume 103, Issue 8, pages 1108–1110, April 2009
How to Cite
Patil, N., Krane, L., Javed, K., Williams, T., Bhandari, M. and Menon, M. (2009), Evaluating and grading cystographic leakage: correlation with clinical outcomes in patients undergoing robotic prostatectomy. BJU International, 103: 1108–1110. doi: 10.1111/j.1464-410X.2008.08168.x
- Issue published online: 26 MAR 2009
- Article first published online: 18 NOV 2008
- Accepted for publication 8 August 2008
- urinary leak;
- radical prostatectomy;
- anastomotic leak;
To classify cystographically detected urinary leaks in patients undergoing computer-assisted (robotic) radical prostatectomy (RP) and to evaluate its effect on postoperative outcomes.
PATIENTS AND 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.
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.
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.