What causes excess drainage following iatrogenic ureteral injury repair and how is it treated?

Updated: Nov 12, 2020
  • Author: Sandip P Vasavada, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

The most common postoperative complication is excess drainage from the Penrose or JP drain. This may indicate the presence of a significant urine leak, either at the ureteral anastomosis or at the bladder closure.

Often, if the peritoneum is not closed or is closed incompletely, peritoneal fluid leaks from the drain, which may confound the situation. Although intraoperative efforts are made to avoid this situation, if one needs to differentiate a urine leak from peritoneal fluid, the fluid may be tested for the creatinine level. If the creatinine level is significantly greater than the serum creatinine measurement, a urine leak is suspected. If the fluid creatinine level is identical to the serum creatinine measurement, the fluid is transudative in nature and is likely peritoneal fluid.

The treatment for most cases of excess drainage is observation. Most often, the drainage tapers with time as the ureteral or bladder wall heals and seals the urine from the drain.

Persistent, long-term output from drain occurs occasionally and implies obstruction either at or beyond the anastomotic site. The most common causes of obstruction include a lack of bladder decompression, stricture at the anastomotic site, or technical error.


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