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Multiple Factor Analysis of Urine Leaks after Retroperitoneal Laparoscopic Partial Nephrectomy

Laparoscopic partial nephrectomy (LPN) is increasingly becoming a definitive therapeutic option for the treatment of small (less than 4 cm) and select moderate-sized (less than 7 cm) renal tumors. Postoperative hemorrhage and urine leak are the most pertinent complications after nephron-sparing surgery, open or laparoscopic. To our knowledge, the risk factors of urine leaks after retroperitoneal LPN have not been studied. We retrospectively analyzed our experience with retroperitoneal LPN to determine risk factors for postoperative urine leak complications. The records of 236 patients who underwent retroperitoneal LPN for renal tumor from March 2003 to October 2010 were reviewed retrospectively. Urine leak was strictly defined as continued urine output from the drain after postoperative day 2. In our series, 39 patients (16.5%) had urine leak complications. On multivariate analysis, mean estimated blood loss (p = 0.0120) and computed tomography angiogram (CTA) examination (p = 0.0286) were independent predictive factors of urine leaks. Moreover, the intraoperative blood loss was significantly reduced in patients undergoing CTA examination (p = 0.0375). Our investigation showed that factors such as intraoperative blood loss and CTA examination are predictors of urine leaks after retroperitoneal LPN. Less intraoperative blood loss to obtain a clear operative field and meticulous suturing technique are necessary to reduce urine leak probability.