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Urinary fistulae after partial nephrectomy.

Shilajit D Kundu1, R Houston Thompson, George J Kallingal

  • 1Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.

BJU International
|March 17, 2010
PubMed
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Urinary fistulas (UF) after partial nephrectomy (PN) occur in 4.4% of cases. Larger tumors, increased blood loss, and longer ischemia time are risk factors for UF development, which often resolves with conservative management.

Area of Science:

  • Urology
  • Surgical Oncology

Background:

  • Urinary fistula (UF) is a potential complication following partial nephrectomy (PN).
  • While reported in 3-6% of large series, risk factors and natural history require further elucidation.

Purpose of the Study:

  • To identify risk factors for urinary fistula (UF) development after partial nephrectomy (PN).
  • To describe the natural history and management of UF in a large patient cohort.

Main Methods:

  • Retrospective review of 1118 partial nephrectomies (PN) at a single tertiary-care institution.
  • Patients with persistent flank drainage (>14 days) or post-drain UF presentation were identified.
  • Risk factors and UF course were analyzed.

Main Results:

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  • A urinary fistula (UF) developed in 4.4% of patients post-PN.
  • Risk factors included larger tumor size (>2.5 cm), higher estimated blood loss, and longer ischemia time.
  • Most UFs (69%) resolved conservatively with percutaneous drainage; 31% required intervention (e.g., stenting).

    • Conclusions:

    • The incidence of urinary fistula (UF) after partial nephrectomy (PN) is low.
    • Tumor size, blood loss, and ischemia time are associated with UF development.
    • Conservative management is effective for asymptomatic UF, with most cases resolving without intervention.