How is a urinary fistula treated following a partial nephrectomy nephron-sparing surgery (NSS)?

Updated: Mar 31, 2019
  • Author: Reza Ghavamian, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Recognized entry into the collecting system intraoperatively requires surgical repair. Failure to do so can result in postoperative urinoma. Risk factors include central location, larger tumor size, and increased complexity of the nephron-sparing operation. A small amount of urinary leakage is conceivably common and usually ceases spontaneously. Persistent drainage through the drain suggests a larger leak, which can still be managed expectantly. In the absence of ureteral obstruction, most leaks seal as more tissue healing occurs. If a urinoma forms after the flank drain has been removed, placement of a percutaneous drainage catheter in the urinoma is indicated to prevent abscess formation. Also, draining the collecting system with a percutaneous nephrostomy tube or, preferably, with a ureteral stent to seal the leakage site in the collecting system, is often helpful.

A study by Potretzke et al evaluated the incidence of and risk factors for a urine leak in robot-assisted partial nephrectomy. The study found that out of a database of 1,791 patients who underwent robot-assisted partial nephrectomy, urine leak was noted in only 14 patients (0.78%). A literature review by the same study found that the historical incidence of urine leak for open partial nephrectomy and laparoscopic partial nephrectomy ranged from 1.0% to 17.4% for open and from 1.6% to 16.5% for laparoscopic.


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