Robotic Assisted Laparoscopic Ureteral Re-implant: Can post operative urinary retention be predicted?
Trudy Kawal, MD, Arun Srinivasan, MD, David Chu, MD, Jason Van Batavia, MD, Christopher Long, MD, Aseem Shukla, MD.
Children's Hospital of Philadelphia, Philadelphia, PA, USA.
BACKGROUND: Urinary retention following extravesical RALUR is proposed to be due to traction or injury of the pelvic parasympathetic nerve plexus during distal ureteral dissection. Nerve sparing techniques have been employed to avoid direct and/or indirect injury to the pelvic plexus. This study assesses post-op urinary retention rates after extravesical RALUR at a single center and investigates whether patient or surgery factors can predict this occurrence. We hypothesized that urinary retention rates would be low and associated with bilateral repair.
METHODS:All RALUR cases entered into an IRB approved registry between 2012-2016 were retrospectively reviewed and the rate of post-op retention was determined. Post-op urinary retention was defined as the need for catheterization at any time in the post op period during hospital admission or within one week post op. Reasons for catheterization included acute urinary retention episodes (AUR) as well as high post void residuals (>50% of expected bladder capacity) on ultrasound bladder scans. Univariate and multivariate analyses were performed to analyze for predictors of post op retention. Factors assessed included age, gender, presentation, bowel bladder dysfunction (BBD), pre-op UTI, OR time and unilateral vs bilateral surgery.
RESULTS: 128 patients underwent extravesical RALUR in 179 ureters during the study period. Male to female ratio was 1:2.6. Age at surgery ranged from 6 months to 17 years with a median of 4 years. Bilateral RALUR was performed in 52 cases (40.6%), and unilateral surgery was done in 76 (59.4%). Urinary retention requiring catheterization occurred in 11 cases (8.59%). Of these 7 were postop bilateral RALUR while unilateral RALUR was done in the remaining 4 instances. In 7 cases, post-op retention occurred within 24 hours following RALUR. The remaining 3 instances occurred within one week despite successful voiding in the immediate post op period. Univariate analysis revealed male gender (p=0.009) and OR time (p=0.029) as predictors of post op retention. No association was found between age, weight, bowel bladder dysfunction, pre-op UTI or laterality and incidence of post-op urinary retention on univariate or multivariate analysis.
CONCLUSIONS: Urinary retention after RALUR is an infrequent complication occurring in less than 9% of patients in our single institution series. When it does occur, urinary retention appears to be secondary to covariates such as male gender and length of surgical time—possibly an indication of technical difficulty—rather than unilaterality vs. bilaterality of repair.
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