Urine colour as an indicator for anastomotic leakage after robot-assisted radical prostatectomy

Abstract

Objectives: To determine whether macroscopic haematuria predicts urethrovesical anastomotic leakage after robot-assisted laparoscopic radical prostatectomy (RALP) as well as a cystogram.

Patients and methods: Participants were recruited before cystogram and catheter removal 5–14 days after RALP surgery. Urine colour in the collection bag was classified according to a three-step scale (clear, light red and dark red) and leakages in cystogram were graded with a four-step scale (Grade 0–3). Diagnostic accuracy parameters were calculated for urine colour. A multivariate logistic regression model was used to evaluate other leakage risk factors.

Results: Of 214 patients, 201 (94%) had clear, six (3%) had light red and seven (3%) had dark red coloured urine. In the cystogram, 20 (9%) patients had leakage; 14 had Grade 1, five Grade 2 and one Grade 3 leakage. Overall, specificity and sensitivity of urine colour in predicting anastomotic leakage were 0.97 (95% CI = 0.95–100) and 0.38 (95% CI = 0.17–0.59), respectively. Negative and positive predictive values were 94% and 62%, respectively. Other significant risk factors for anastomotic leakage were previous transurethral resection or radiation therapy to the prostate, non-waterproof anastomosis at surgery, postoperative pelvic haematoma, long catheterization and surgeon’s inexperience. In patients with no other risk factors, test sensitivity improved to 0.80 (95% CI = 0.45–1.15) and negative and positive predictive values to 99% and 44%, respectively.

Conclusion: This prospective single-arm trial indicates that in patients with clear urine and no other risk factors for anastomotic leakage, a cystogram examination before urethral catheter removal can be safely omitted.

Keywords:

• Robot-assisted radical prostatectomy
• cystogram
• urine colour
• anastomosis
• anastomotic leakage

Acknowledgements

We would like to acknowledge nurses Jaana Saarinen and Jari Peltonen, who took photographs and analysed the urinary colours, Mika Helminen, who helped us in the statistical analysis, and Dr. Ewen MacDonald, for improvements to language of the manuscript.

Disclosure statement

Tomi Pakarainen, Aino Siltari, Juha-Pekka Pienimäki and Juha Koskimäki: Nothing to declare. Jarno Riikonen: Reimbursements for travel and conferences: Swanmedica. Trial participation: Bayer, Orion. Teemu Murtola: Consultation fees from Astellas and Janssen. Lecture fees from Astellas and Janssen. Reimbursements for travel and conferences: Janssen.

Authors’ contribution

Jarno Riikonen, Tomi Pakarainen, Juha-Pekka Pienimäki, Juha Koskimäki and Teemu Murtola performed the research. Jarno Riikonen, Tomi Pakarainen and Teemu Murtola designed the research study. Jarno Riikonen, Tomi Pakarainen, Aino Siltari, Juha-Pekka Pienimäki and Teemu Murtola analysed the data. Jarno Riikonen, Aino Siltari and Teemu Murtola wrote the manuscript. All authors have approved the final version of the manuscript.

Additional information

Funding

This study was funded by Expert Responsibility Area of the Pirkanmaa Hospital District [grant number 9X032] and Cancer Society of Finland [grant number 25024194].