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Impact of the severity of urethrovesical anastomotic leakage on urinary continence following robot-assisted laparoscopic prostatectomy

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Abstract

We assessed whether the severity of anastomotic urinary leakage detected during routine cystourethrography after robot-assisted laparoscopic prostatectomy (RALP) affects urinary continence recovery. Around 302 patients who underwent RALP between August 2013 and May 2019 were included retrospectively. According to routine cystourethrographic findings obtained on the sixth or eighth postoperative day, which indicated leakage severity, patients were divided into three groups: no-leakage, grade 1 (linear shaped leakage, but not spreading), and grade 2 (spreading strip-shaped leakage). The preoperative factors and intraoperative factors were compared between no-leakage and leakage group (grade 1 and grade 2). Continence recovery was compared between the three groups. Continence recovery was defined as no pad used or one security pad used in a day. Cystourethrography revealed anastomotic urinary leakage in 44 patients (14.5%), of which 20 patients (6.6%) had grade 1 leakage and 24 patients (7.9%) had grade 2 leakage. On multivariate logistic regression analysis, the only significant predictor for urethrovesical anastomotic urinary leakage on cystourethrography following RALP was intraoperative anastomotic leakage (OR 5.306; 95% CI 1.530–18.398, p = 0.009). Continence recovery rates for no-leakage, grade 1 leakage, and grade 2 leakage groups were 11%, 20%, and 25% after 1 month (P = 0.131); 25%, 25%, and 45.8% after 3 months (P = 0.474); 44.6%, 55%, and 60.8% after 6 months (P = 0.184); and 63.1%, 87.5%, and 78.2% after 12 months (P = 0.095), respectively. In conclusion, urinary leakage in urethrovesical anastomosis, even at its severity, had no negative effects on continence recovery after RALP.

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Data availability

The datasets available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Urology, Faculty of Medicine, Kagawa University, Kagawa, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan

    Yoichiro Tohi, Kana Kohashiguchi, Takayoshi Miura, Yasuyuki Miyauchi, Yuki Matsuoka, Takuma Kato, Rikiya Taoka, Hiroyuki Tsunemori, Nobufumi Ueda & Mikio Sugimoto

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  1. Yoichiro Tohi
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  2. Kana Kohashiguchi
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  3. Takayoshi Miura
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  4. Yasuyuki Miyauchi
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  5. Yuki Matsuoka
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  6. Takuma Kato
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  7. Rikiya Taoka
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  8. Hiroyuki Tsunemori
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  9. Nobufumi Ueda
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  10. Mikio Sugimoto
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Contributions

Research conception and design: YT. Data acquisition: YT, KK, TM, YM, YM, TK, RT, HT, NU, MS Statistical analysis: YT. Data analysis and interpretation: YT. Drafting of the manuscript: YT. Critical revision of the manuscript: KK, TM, YM, YM, TK, RT, HT, NU, MS. Obtaining funding: None. Administrative, technical, or material support: None. Supervision: MS. Approval of the final manuscript: All authors.

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Correspondence to Yoichiro Tohi.

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This study was approved by the Institutional Review Board of Kagawa University (Permission number: 2020–014).

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Need for informed consent was waived given the retrospective nature of the study, but information of this study was disclosed on the web-site and opportunities for refusal were guaranteed.

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Tohi, Y., Kohashiguchi, K., Miura, T. et al. Impact of the severity of urethrovesical anastomotic leakage on urinary continence following robot-assisted laparoscopic prostatectomy. J Robotic Surg 16, 1175–1181 (2022). https://doi.org/10.1007/s11701-021-01357-7

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  • DOI: https://doi.org/10.1007/s11701-021-01357-7

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