Urine Drain May Not Be Needed After Partial Nephrectomy

Select patients may not need a perinephric drain to prevent urinary collection (urinoma) following a partial nephrectomy, according to a new study.

Researchers at Memorial Sloan-Kettering Cancer Center (MSKCC; New York, NY, USA) reviewed a surgery database and identified 512 consecutive open partial nephrectomies for superficial renal cortical tumors, performed using a standardized technique by a single surgeon between January 2005 and May 2009. The study group included 75 evaluable patients (median age 64 years, 56.8% male) who did not have a drain placed. Clinical data, surgical information, histological type, and postoperative complications within 90 days of the procedure using the modified Clavien system were included in the analysis.

The results showed that the median tumor size was two centimeters, and more than 70% were malignant. A total of 38 patients (50.7%) underwent renal artery clamping and cold ischemia with a median clamp time of 30 minutes. The overall complication rate was 13.3% (10 patients); in four patients (5.3%) complications were related to an absent drain, and included a grade I urinary leak, a grade II perirenal collection, a grade III urinoma requiring percutaneous drainage, and a grade III urinary leak with urosepsis, respectively. All were resolved, and there were no deaths in the entire series. The study was published early online in the June 17, 2011, issue of the Journal of Urology.

“In suitable candidates, not putting in a drain is a safe and prudent thing to do and can lessen patient discomfort, decrease the chance of a drain-induced nosocomial infection, or the complication of a retained drain fragment upon removal,” said senior author urologic oncological surgeon Paul Russo, MD. “Late urinomas can still occur, whether an immediate post op drain is placed or not, and hence vigilant post op care is still required after partial nephrectomy.”

Urine leaks and urinomas result from disruption of the urinary collecting system at any level from the calix to the urethra. Urinomas may initially be clinically occult and may manifest with delayed complications such as hydronephrosis, paralytic ileus, electrolyte imbalances, and abscess formation.

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Memorial Sloan-Kettering Cancer Center