Systematic review on active treatment for urinary fistula after partial nephrectomy

Area of Science:

• Urology
• Nephrology
• Surgical Oncology

Background:

• Partial nephrectomy is increasingly indicated due to comparable oncological outcomes to radical nephrectomy, with added benefits of reduced chronic kidney disease risk and mortality.
• This trend is expected to increase the incidence of urinary fistula, a potential complication requiring effective management strategies.
• Active management of urinary fistulas post-partial nephrectomy is crucial for patient recovery and renal function preservation.

Purpose of the Study:

• To review and compare contemporary active management techniques for urinary fistula following partial nephrectomy.
• To evaluate the efficacy and outcomes of various treatment approaches for post-partial nephrectomy urinary leaks.

Main Methods:

• A systematic literature search was conducted on MEDLINE in March 2020, using keywords related to urinary fistula and partial nephrectomy.
• The review adhered to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, focusing on articles detailing active treatment.
• Abstracts in English and Spanish from the past two decades were screened, with no restrictions on study design or follow-up duration.

Main Results:

• Multiple studies were identified, though no randomized controlled trials were found.
• Active treatment for urinary fistula demonstrated a high overall resolution rate of 97.5%.
• Resolution was achieved with an average of 1.4 interventions per patient, with a mean leak resolution time of 11 days (median 3 days).

Conclusions:

• Urinary fistulas after partial nephrectomy can be effectively managed with a variety of active treatment strategies.
• The high success rate and relatively short resolution time underscore the efficacy of contemporary management approaches.
• Methodological limitations in the reviewed studies suggest a high risk of bias, necessitating cautious interpretation of results.