Urinary fistulae after partial nephrectomy

Shilajit D. Kundu, R. Houston Thompson, George J. Kallingal, Gina Cambareri, Paul Russo*

*Corresponding author for this work

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

OBJECTIVE To report the risk factors and natural history of urinary fistula (UF) after partial nephrectomy (PN), as their incidence has been reported to be 3-6% in large series of PN but there are few reports of the risk factors associated with the development of UF after PN, and the natural history of UF in a large group of patients. PATIENTS AND METHODS This was a retrospective review of 1118PN at one tertiary-care institution. Most patients had a drain placed in the perinephric space after surgery. Fifty-two patients were identified as having a UF if they had persistent flank drainage for >14 days after surgery, or presented with evidence of a UF after the drain had been removed. Risk factors for development and the course of the UF are reported. RESULTS Fifty-two patients developed a UF after PN (4.4%, 95% confidence interval, CI, 3.5-6.1%) The rate of a persistent urine leak (defined as drain fluid consistent with urine for >2 weeks after surgery) was 4.0 (95% CI 2.9-5.3)%. The overall rate of delayed UF presentation was only 0.4 (0.09-0.9)%. Patients who developed a UF had larger tumours (3.5 vs 2.6cm, P = 0.03), a higher estimated blood loss (400 vs 300mL, P < 0.001), and longer ischaemia time (50 vs 39min, P < 0.001) than patients who did not develop a UF. Differences in tumour histology, laterality, multifocality, type of surgery (laparoscopic vs open), and intraoperative collecting system entry were not statistically different in patients who did or did not develop a UF. Patients with tumours of >2.5cm were twice as likely to develop a UF than patients with tumours of <2.5cm (P = 0.02). Most patients were managed conservatively with a percutaneous drain until the UF resolved, if they were asymptomatic. Overall, in 36 patients (69%) the fistula resolved with no intervention, while 16 (31%) required intervention. Stenting was the commonest intervention (15%). No patient required re-operative open surgery. CONCLUSION The rate of development of UF after PN is low. Tumour size, blood loss and ischaemia time were all associated with the development of a UF. In most patients with a urine leak immediately after surgery the UF will resolve with no intervention, and can be managed conservatively with patience, in the absence of clinical symptoms.

Original languageEnglish (US)
Pages (from-to)1042-1044
Number of pages3
JournalBJU International
Volume106
Issue number7
DOIs
StatePublished - Oct 1 2010

Fingerprint

Urinary Fistula
Nephrectomy
Urine
Neoplasms
Tertiary Healthcare

Keywords

  • complications
  • partial nephrectomy
  • urinary fistula

ASJC Scopus subject areas

  • Urology
  • Medicine(all)

Cite this

Kundu, S. D., Thompson, R. H., Kallingal, G. J., Cambareri, G., & Russo, P. (2010). Urinary fistulae after partial nephrectomy. BJU International, 106(7), 1042-1044. https://doi.org/10.1111/j.1464-410X.2010.09230.x
Kundu, Shilajit D. ; Thompson, R. Houston ; Kallingal, George J. ; Cambareri, Gina ; Russo, Paul. / Urinary fistulae after partial nephrectomy. In: BJU International. 2010 ; Vol. 106, No. 7. pp. 1042-1044.
@article{71bf9641c4e74b02a5effe4d22a7a65c,
title = "Urinary fistulae after partial nephrectomy",
abstract = "OBJECTIVE To report the risk factors and natural history of urinary fistula (UF) after partial nephrectomy (PN), as their incidence has been reported to be 3-6{\%} in large series of PN but there are few reports of the risk factors associated with the development of UF after PN, and the natural history of UF in a large group of patients. PATIENTS AND METHODS This was a retrospective review of 1118PN at one tertiary-care institution. Most patients had a drain placed in the perinephric space after surgery. Fifty-two patients were identified as having a UF if they had persistent flank drainage for >14 days after surgery, or presented with evidence of a UF after the drain had been removed. Risk factors for development and the course of the UF are reported. RESULTS Fifty-two patients developed a UF after PN (4.4{\%}, 95{\%} confidence interval, CI, 3.5-6.1{\%}) The rate of a persistent urine leak (defined as drain fluid consistent with urine for >2 weeks after surgery) was 4.0 (95{\%} CI 2.9-5.3){\%}. The overall rate of delayed UF presentation was only 0.4 (0.09-0.9){\%}. Patients who developed a UF had larger tumours (3.5 vs 2.6cm, P = 0.03), a higher estimated blood loss (400 vs 300mL, P < 0.001), and longer ischaemia time (50 vs 39min, P < 0.001) than patients who did not develop a UF. Differences in tumour histology, laterality, multifocality, type of surgery (laparoscopic vs open), and intraoperative collecting system entry were not statistically different in patients who did or did not develop a UF. Patients with tumours of >2.5cm were twice as likely to develop a UF than patients with tumours of <2.5cm (P = 0.02). Most patients were managed conservatively with a percutaneous drain until the UF resolved, if they were asymptomatic. Overall, in 36 patients (69{\%}) the fistula resolved with no intervention, while 16 (31{\%}) required intervention. Stenting was the commonest intervention (15{\%}). No patient required re-operative open surgery. CONCLUSION The rate of development of UF after PN is low. Tumour size, blood loss and ischaemia time were all associated with the development of a UF. In most patients with a urine leak immediately after surgery the UF will resolve with no intervention, and can be managed conservatively with patience, in the absence of clinical symptoms.",
keywords = "complications, partial nephrectomy, urinary fistula",
author = "Kundu, {Shilajit D.} and Thompson, {R. Houston} and Kallingal, {George J.} and Gina Cambareri and Paul Russo",
year = "2010",
month = "10",
day = "1",
doi = "10.1111/j.1464-410X.2010.09230.x",
language = "English (US)",
volume = "106",
pages = "1042--1044",
journal = "BJU International",
issn = "1464-4096",
publisher = "Wiley-Blackwell",
number = "7",

}

Kundu, SD, Thompson, RH, Kallingal, GJ, Cambareri, G & Russo, P 2010, 'Urinary fistulae after partial nephrectomy', BJU International, vol. 106, no. 7, pp. 1042-1044. https://doi.org/10.1111/j.1464-410X.2010.09230.x

Urinary fistulae after partial nephrectomy. / Kundu, Shilajit D.; Thompson, R. Houston; Kallingal, George J.; Cambareri, Gina; Russo, Paul.

In: BJU International, Vol. 106, No. 7, 01.10.2010, p. 1042-1044.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Urinary fistulae after partial nephrectomy

AU - Kundu, Shilajit D.

AU - Thompson, R. Houston

AU - Kallingal, George J.

AU - Cambareri, Gina

AU - Russo, Paul

PY - 2010/10/1

Y1 - 2010/10/1

N2 - OBJECTIVE To report the risk factors and natural history of urinary fistula (UF) after partial nephrectomy (PN), as their incidence has been reported to be 3-6% in large series of PN but there are few reports of the risk factors associated with the development of UF after PN, and the natural history of UF in a large group of patients. PATIENTS AND METHODS This was a retrospective review of 1118PN at one tertiary-care institution. Most patients had a drain placed in the perinephric space after surgery. Fifty-two patients were identified as having a UF if they had persistent flank drainage for >14 days after surgery, or presented with evidence of a UF after the drain had been removed. Risk factors for development and the course of the UF are reported. RESULTS Fifty-two patients developed a UF after PN (4.4%, 95% confidence interval, CI, 3.5-6.1%) The rate of a persistent urine leak (defined as drain fluid consistent with urine for >2 weeks after surgery) was 4.0 (95% CI 2.9-5.3)%. The overall rate of delayed UF presentation was only 0.4 (0.09-0.9)%. Patients who developed a UF had larger tumours (3.5 vs 2.6cm, P = 0.03), a higher estimated blood loss (400 vs 300mL, P < 0.001), and longer ischaemia time (50 vs 39min, P < 0.001) than patients who did not develop a UF. Differences in tumour histology, laterality, multifocality, type of surgery (laparoscopic vs open), and intraoperative collecting system entry were not statistically different in patients who did or did not develop a UF. Patients with tumours of >2.5cm were twice as likely to develop a UF than patients with tumours of <2.5cm (P = 0.02). Most patients were managed conservatively with a percutaneous drain until the UF resolved, if they were asymptomatic. Overall, in 36 patients (69%) the fistula resolved with no intervention, while 16 (31%) required intervention. Stenting was the commonest intervention (15%). No patient required re-operative open surgery. CONCLUSION The rate of development of UF after PN is low. Tumour size, blood loss and ischaemia time were all associated with the development of a UF. In most patients with a urine leak immediately after surgery the UF will resolve with no intervention, and can be managed conservatively with patience, in the absence of clinical symptoms.

AB - OBJECTIVE To report the risk factors and natural history of urinary fistula (UF) after partial nephrectomy (PN), as their incidence has been reported to be 3-6% in large series of PN but there are few reports of the risk factors associated with the development of UF after PN, and the natural history of UF in a large group of patients. PATIENTS AND METHODS This was a retrospective review of 1118PN at one tertiary-care institution. Most patients had a drain placed in the perinephric space after surgery. Fifty-two patients were identified as having a UF if they had persistent flank drainage for >14 days after surgery, or presented with evidence of a UF after the drain had been removed. Risk factors for development and the course of the UF are reported. RESULTS Fifty-two patients developed a UF after PN (4.4%, 95% confidence interval, CI, 3.5-6.1%) The rate of a persistent urine leak (defined as drain fluid consistent with urine for >2 weeks after surgery) was 4.0 (95% CI 2.9-5.3)%. The overall rate of delayed UF presentation was only 0.4 (0.09-0.9)%. Patients who developed a UF had larger tumours (3.5 vs 2.6cm, P = 0.03), a higher estimated blood loss (400 vs 300mL, P < 0.001), and longer ischaemia time (50 vs 39min, P < 0.001) than patients who did not develop a UF. Differences in tumour histology, laterality, multifocality, type of surgery (laparoscopic vs open), and intraoperative collecting system entry were not statistically different in patients who did or did not develop a UF. Patients with tumours of >2.5cm were twice as likely to develop a UF than patients with tumours of <2.5cm (P = 0.02). Most patients were managed conservatively with a percutaneous drain until the UF resolved, if they were asymptomatic. Overall, in 36 patients (69%) the fistula resolved with no intervention, while 16 (31%) required intervention. Stenting was the commonest intervention (15%). No patient required re-operative open surgery. CONCLUSION The rate of development of UF after PN is low. Tumour size, blood loss and ischaemia time were all associated with the development of a UF. In most patients with a urine leak immediately after surgery the UF will resolve with no intervention, and can be managed conservatively with patience, in the absence of clinical symptoms.

KW - complications

KW - partial nephrectomy

KW - urinary fistula

UR - http://www.scopus.com/inward/record.url?scp=77956641784&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77956641784&partnerID=8YFLogxK

U2 - 10.1111/j.1464-410X.2010.09230.x

DO - 10.1111/j.1464-410X.2010.09230.x

M3 - Article

VL - 106

SP - 1042

EP - 1044

JO - BJU International

JF - BJU International

SN - 1464-4096

IS - 7

ER -

Kundu SD, Thompson RH, Kallingal GJ, Cambareri G, Russo P. Urinary fistulae after partial nephrectomy. BJU International. 2010 Oct 1;106(7):1042-1044. https://doi.org/10.1111/j.1464-410X.2010.09230.x