Jackson Pratt Drain Creatinine Value Is a Predictive Marker for Assessment of Urethrovesical Anastomosis after Robotic Assisted Laparoscopic Prostatectomy
SIU Academy®. Patel K. 09/10/13; 33344; RF-01.03 Topic: Surgery
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Dr. Kalpit Patel
Dr. Kalpit Patel
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Jackson Pratt Drain Creatinine Value Is a Predictive Marker for Assessment of Urethrovesical Anastomosis After Robotic Assisted Laparoscopic Prostatectomy

Patel, Kalpit MD, Nething, Joshua MD, Adamic, Brittany, Stakleff, Kimberly, Ricchiuti, Daniel MD

Introduction and Objectives: We assess the correlation between Jackson Pratt (JP) drain fluid creatinine (Cr) level on post-operative day 1 (POD 1) after robotic assisted laparoscopic prostatectomy (RALP) with cystogram findings one week after surgery. Our hypothesis is that JP drain fluid Cr can be used as a simple test to confirm the absence of urethrovesical anastomotic leak (UVAL), and thereby safely eliminating the need for routine cystography or the potential risks of premature Foley removal without any confirmatory imaging study.

Materials and Methods: A retrospective chart review was conducted on all patients undergoing RALP from 2007-2012. POD 1 JP and serum Cr and POD 7 cystogram results were recorded. Exclusion criteria included patients with no recorded POD 1 JP or serum Cr, and patients with cystogram not performed on POD 7. A total of 249 patients were ultimately analyzed using SPSS 16.0 statistical analysis. A positive JP Cr suspicious for UVAL was identified as JP Cr > 1 mg/dL over serum Cr. Negative predictive value (NPV) of a negative JP Cr (JP Cr within 1 mg/dL of serum Cr) compared to negative cystogram was computed.

Results: A total of 23 (9.2%) patients were identified as having UVAL on POD 7 cystogram. Using a cutoff value of JP Cr > 1 mg/dL over serum Cr identified 23 (9.2%) patients in the series. When POD 1 JP and serum Cr were within 1 mg/dL, the NPV of determining UVAL was 92.9%. In addition, the specificity of this JP Cr test was 92.9% for confirmation of no evidence of UVAL on cystogram.

Conclusion: It is important to ascertain the absence of an UVAL prior to Foley catheter removal after RALP, to avoid complications such as urinoma, strictures, or ileus. POD 1 JP Cr is a clinically useful marker and relatively simple test to assess for UVAL, while avoiding the need for routine cystography and concurrently allowing for safe catheter removal.
Jackson Pratt Drain Creatinine Value Is a Predictive Marker for Assessment of Urethrovesical Anastomosis After Robotic Assisted Laparoscopic Prostatectomy

Patel, Kalpit MD, Nething, Joshua MD, Adamic, Brittany, Stakleff, Kimberly, Ricchiuti, Daniel MD

Introduction and Objectives: We assess the correlation between Jackson Pratt (JP) drain fluid creatinine (Cr) level on post-operative day 1 (POD 1) after robotic assisted laparoscopic prostatectomy (RALP) with cystogram findings one week after surgery. Our hypothesis is that JP drain fluid Cr can be used as a simple test to confirm the absence of urethrovesical anastomotic leak (UVAL), and thereby safely eliminating the need for routine cystography or the potential risks of premature Foley removal without any confirmatory imaging study.

Materials and Methods: A retrospective chart review was conducted on all patients undergoing RALP from 2007-2012. POD 1 JP and serum Cr and POD 7 cystogram results were recorded. Exclusion criteria included patients with no recorded POD 1 JP or serum Cr, and patients with cystogram not performed on POD 7. A total of 249 patients were ultimately analyzed using SPSS 16.0 statistical analysis. A positive JP Cr suspicious for UVAL was identified as JP Cr > 1 mg/dL over serum Cr. Negative predictive value (NPV) of a negative JP Cr (JP Cr within 1 mg/dL of serum Cr) compared to negative cystogram was computed.

Results: A total of 23 (9.2%) patients were identified as having UVAL on POD 7 cystogram. Using a cutoff value of JP Cr > 1 mg/dL over serum Cr identified 23 (9.2%) patients in the series. When POD 1 JP and serum Cr were within 1 mg/dL, the NPV of determining UVAL was 92.9%. In addition, the specificity of this JP Cr test was 92.9% for confirmation of no evidence of UVAL on cystogram.

Conclusion: It is important to ascertain the absence of an UVAL prior to Foley catheter removal after RALP, to avoid complications such as urinoma, strictures, or ileus. POD 1 JP Cr is a clinically useful marker and relatively simple test to assess for UVAL, while avoiding the need for routine cystography and concurrently allowing for safe catheter removal.
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