Persistent haematuria after laparoscopic radical prostatectomy can predict urinary leakage at the vesicourethral anastomosis?
The aim of this investigation was to determine whether postoperative haematuria could be used as a predictor for the presence or absence of a urinary leakage at the vesicourethral anastomosis after laparoscopic extraperitoneal radical prostatectomy for localized prostate cancer.
MATERIAL AND METHODS:
In this preliminary study, the urine colour of 50 patients who underwent laparoscopic extraperitoneal radical prostatectomy due to histologically proven localized prostate cancer was assessed macroscopically and microscopically on postoperative day (POD) 4, 5 and 6. All patients underwent evaluation of perianastomotic extravasation by trans-rectal ultrasound (TRUS) on POD 6. Baseline characteristics included age; prostate-specific antigen; prostate volume; tumour, node, metastasis classification; and Gleason score.
The urine colour was a highly significant predictor for perianastomotic extravasation in TRUS when it was red on POD 4, 5 and 6. The sensitivity and specificity of urine colour as a predictor for extravasation were 71.4% and 83.2% on POD 4, 71.4% and 85.8% on POD 5, and 81.8% and 90.9% on POD 6, respectively, with a clear or slightly ensanguined urine colour. The negative and positive predictive values were 98.6% and 81.8%, respectively.
Persistent haematuria shows an increased risk of missing a perianastomotic extravasation diagnosticated at transrectal ultrasound.