Background: A fundamental difference between open and laparoscopic radical prostatectomy (LRP) is the ability to perform a running urethrovesical (UV) anastomosis. Routine pelvic drainage to identify and prevent complications is common after open surgery. Our goal is to reassess the need for drain placement following LRP with a running UV anastomosis.
Methods: A retrospective chart review was performed for all patients undergoing LRP between January 2003 and December 2004. Clinical and pathological information was recorded. All patients underwent either trans- or extraperitoneal LRP as previously described. The UV anastomosis was performed with two 2-0 monocryl sutures tied in the midline. The anastomotic integrity was tested by distending the bladder with saline. A drain was placed at the discretion of the senior surgeon when a leak was noted at the anastomosis or a complex bladder neck reconstruction was performed. If drainage was minimal postoperatively, then the drain was removed within 24 hours. Routine postoperative cystograms were obtained within 1 week after surgery, and all studies were reviewed for demonstrable urine leak. Complete abdominal examination was performed at defined intervals postoperatively. Charts were also reviewed for clinical or radiographic evidence of urinoma, lymphocele, abscess, and hematoma.
Results: 208 patients underwent LRP with a running UV anastomosis. Data including cystogram was available for 206. There was no significant difference between patients with or without drains placed with regard to demographics or tumor characteristics. The overall rate of cystographic urine leak was 4.9%. A drain was placed in 51 (24.7%) patients. Of these, 7 (13.7%) had a postoperative leak on cystogram. Of the 155 patients in whom no drain was placed, urine leak was demonstrated in 3 (2.0%). The higher leak rate in the drained vs. the undrained cohort was statistically significant (Fisher’s exact test, p=0.0026). All ten leaks resolved with prolonged catheter drainage. There were no urinomas, hematomas, or abscesses in either group.
Conclusions: Routine placement of a pelvic drain after LRP is not necessary when the UV anastomosis is performed in a running fashion, unless the suspicion for urinary extravasation is high or a complex bladder neck reconstruction is performed. Experienced clinical judgment is essential and accurate in identifying patients at risk for postoperative UV anastomotic leakage. When suspicion is low, a drain may be omitted with no increase in morbidity.

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