Introduction: Over the last decade, the annual volume of robotic prostatectomies performed in the United States has steadily risen.
Refinements in surgical technique, understanding of anatomy, and experience has led to more complex patients being offered surgery for management of organ-confined prostate cancer. Complication rates of robotic prostatectomy have been reported in several manuscripts, however a paucity of data exists when evaluating ureteral injuries sustained during robotic prostatectomy. No standardized universal criteria for reporting and grading of complications exists, therefore the Martin-Donat criteria with Clavien-Dindo classification system were used to evaluate ureteral injuries in our series.
Materials and Methods: From January 2001 to June 2013, 6442 consecutive patients were treated with robotic prostatectomy at the same institution by one of five surgeons. All complications were documented through a prospectively maintained prostate cancer database with supplementation from electronic medical records, operative and nursing notes, claims data, discharge summaries, outpatient and emergency visits, institutional morbidity and mortality data as well as National Surgical Quality Improvement Program (NSQIP) data. The Martin-Donat criteria were used to facilitate the accurate and comprehensive reporting of surgical complications while complication severity was assigned following the Clavien-Dindo classification system.
Results: Three patients sustained ureteral injuries (ureteral transection) in our series. Both surgeons were beyond their learning curve (greater than 1000 cases) when the injuries occurred; one patient required readmission and all patients had risk factors predisposing them to ureteral injury. Each patient was managed with Robotic Ureteroneocystostomy (1), Open Transureteroureterostomy (1) and Robotic Ureteroureterostomy (1) respectively.
Conclusions: Ureteral injuries are uncommon, however thorough pre-operative evaluation and surgical planning could identify patients at high-risk for sustaining ureteral injury during prostatectomy. Measures can be taken pre or intraoperatively in order to reduce the probability of ureteral injury eliminating the necessity for additional procedures postoperatively.
Written by:
Jhaveri JK, Penna FJ, Insua M, Jeong W, Menon M, Peabody JO. Are you the author?
Henry Ford Hospital, Vattikuti Urology Institute, Detroit, Michigan, United States;
Reference: J Endourol. 2013 Oct 22. Epub ahead of print.
doi: 10.1089/end.2013.0564
PubMed Abstract
PMID: 24147874
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