Abstract: PD66-10
Sources of Funding: None

Introduction

Bulb suction drain placement is routinely done following robotic-assisted partial nephrectomy secondary to concern for post-operative urine leak. We explore the necessity of bulb suction drain placement and the rate of post-operative urine leaks in patients who underwent robotic-assisted partial nephrectomy at our institution.

Methods

We performed a retrospective chart review to analyze the occurrence of urine leaks following robotic-assisted partial nephrectomy performed by two fellowship trained surgeons between January 2012 to July 2016. Urine leak was defined as drain body fluid creatinine to serum creatinine ratio greater than 5 or any patient with symptomatic urinary ascites within 90 days post-operatively.

Results

Our review included 208 patients who underwent robotic-assisted partial nephrectomy. A total of 124 patients had intra-operative 10 French bulb suction drain placement and 84 patients had drain placement omitted. The mean length of stay for patients who had drain placement versus those who did not was 3.0 and 2.4 days, respectively. In patients who had bulb suction drains, the mean duration the drain was left in place and drain output was 1.7 days and 180.2 mL, respectively. On post-operative day 1, drain-fluid creatinine (ng/dL) was measured, resulting in a mean drain-fluid creatinine to serum creatinine ratio of 0.97 (range 0.73-3.12). The mean tumor size (cm) and R.E.N.A.L. nephrometry score (range score 4-12) in patients with drain placement vs. those without was 3.3, 5.9 and 2.7, 5.2, respectively. There was a statistically significant difference (p= .007) in R.E.N.A.L. score between the two groups, but was ultimately inconsequential in our population. The collecting system was entered in 61 patients (29.3% of cases) resulting in zero urine leaks within this subgroup. No patients were re-admitted 30 to 90 days post-operatively for symptomatic urinary ascites or related complications.

Conclusions

Routine bulb suction drain placement, even in the event of collecting system entry, can safely be omitted following robotic-assisted partial nephrectomy. _x000D_ _x000D_

Funding

None