Mert KILIÇ, Serdar MADENDERE, Arzu BAYGÜL EDEN, Fadimana BOZKURT TEKKALAN, Ersin KÖSEOĞLU, Mevlana Derya BALBAY

Robotik radikal prostatektomi sonrası üretrovezikal anastomoz kaçağının erken postoperatif kontinans üzerine etkisi

Amaç: Bu çalışmada robot yardımlı radikal prostatektomi (RYRP) uygulanan hastalarda üretrovezikal anastomoz kaçağı (UAK) ve ilişkili faktörleri ve bunun erken kontinans üzerine etkisini değerlendirmeyi amaçladık. Gereç ve Yöntemler: Bu retrospektif analizde Şubat 2017 ile Haziran 2022 tarihleri arasında RYRP uygulanan 81 hastanın verileri değerlendirildi. Ameliyat sonrası yedinci günde hastalarda UAK olup olmadığını belirlemek için sistografi çekildi. UAK’ye yol açabilecek faktörleri araştırmak için tek ve çok değişkenli analizler yapıldı. Ameliyattan 6-12 hafta sonra hastalarda kontinans oranları kaydedildi. Bulgular: Toplamda 25 hastada (%31) UAK vardı; 12’si (%15) hafif, 8’i (%10) orta ve 5’i (%6) ileri derecedeydi. Dren/serum kreatinin oranının >1,5 olması ve prostat hacminin >53 cm3 olması UAK’yi öngörmede hem tek değişkenli hem de çok değişkenli analizlerde anlamlı bulundu (sırasıyla p=0,017 ve p=0,046). Postoperatif ikinci veya üçüncü günde dren çıkışı 100 ml’den fazla olan 36 hastanın sekizinde (%22) yüksek dren/serum kreatinin oranı (>1,5) vardı ve bunların yedisinde (%88) UAK vardı. Erken dönem takip verilerine göre UAK’lı hastaların 9 (%36)’sında, UAK’sız hastaların ise 20 (%37)’sinde inkontinans saptandı (p=0,959). Sonuç: Sistografi, RYRP sonrası anastomoz kaçağını tespit etmede etkili bir yöntemdir. Büyük prostat hacmi (>53 cm3) ve yüksek postoperatif dren/serum kreatinin oranı (>1.5) UAK ile ilişkili bulunmuştur. UAK’ın erken kontinans üzerinde etkisi gözlenmemiştir.

Anahtar Kelimeler:

anastomoz kaçağı, idrar kaçırma, robot yardımlı, prostatektomi, sistografi

Impact of urethrovesical anastomotic leakage after robotic radical prostatectomy on early postoperative continence

Objective: This study aimed to assess the urethrovesical anastomotic leakage (UAL) and associated factors in patients who underwent robot-assisted radical prostatectomy (RARP) and its effect on early continence. Material and Methods: The data of 81 patients who underwent RARP between February 2017 and June 2022 were evaluated in this retrospective analysis. On the seventh postoperative day, we performed a cystography to determine whether the patients had UAL. Uni- and multivariate analyses were done to investigate the factors that could lead to UAL. Continence rates were recorded in patients at 6-12 weeks after surgery. Results: Overall 25 patients (31%) had UAL; of them 12 (15%) were mild, eight (10%) were moderate, and five (6%) were extensive. A drain/serum creatinine ratio >1.5 and a prostate volume >53 cm3 were determined to be significant in predicting UAL in both the uni- and multivariate analyses (p=0.017 and p=0.046, respectively). On the postoperative second or third day, of the 36 patients who had drain output greater than 100 ml, eight (22%) had a high drain/serum creatinine ratio (>1.5), seven (88%) of which had UAL. According to the early period follow-up data, incontinence was prevalent in 9 (36%) of the patients with UAL and 20 (%37) of the patients without UAL (p=0.959). Conclusion: Cystography is an effective method for detecting leakage after RARP. A large prostate volume (>53 cm3) and a high postoperative drain/serum creatinine ratio (>1.5) were found to be associated with UAL. UAL had no effect on early continence.e

Keywords:

anastomotic leak, cystography, prostatectomy, robot-assisted, urinary incontinence,

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