Urinary leak after partial nephrectomy: Insights from a cohort with hereditary, multifocal, and reoperative cases.

Purpose: To identify risk factors, surgical considerations, and management strategies associated with urinary leak (UL) following partial nephrectomy (PN) in a cohort that includes a significant number of patients with hereditary renal cancer syndromes, multiple tumors, and a history of prior PNs.

Material and methods: A retrospective chart review was conducted selecting patients who underwent PN at our institution from January 2006 to December 2023 was performed. Clinical, demographic, surgical characteristics, and management strategies were recorded and analyzed.

Results: A total of 1,173 PNs were analyzed, of those 89(7.6%) had a UL. Patients had a median age at surgery of 50[38-59] years, 3[1-6] tumors removed per procedure with a total of 5,947 tumors were removed, 61.6% PN via the robotic approach, and the most common diagnosis was von Hippel-Lindau disease (47.4%). The frequency of UL was 5.1% for first-time PN, 10.4% for second, and 19.6% for third. An increased risk of UL was observed with higher EBL (OR = 1.016; P = 0.006) and decrease with robotic approach (OR = 0.376; P < 0.001). Overall, 44.9% of UL cases were successfully managed with conservative management (postop drain and Foley), while 98.9% were successfully managed with conservative management, ureteral stent placement, percutaneous drain, or nephrostomy tube.

Conclusion: UL is directly associated with the complexity of the surgery. The advantages of robotic-assisted surgery in reducing UL risk indicate potential avenues for improved outcomes. Future efforts should explore the role of intraoperative and postoperative strategies to minimize this complication. Conservative management and drain or catheter placement resolve most of the ULs.