Urine Leak After Partial Nephrectomy: A Rare Complication After Robot-Assisted Partial Nephrectomy

In this systematic review, we looked at the rate of urine leakage from the kidney after surgical removal of kidney tumors. Urine leak (UL) is a common post-operative complication of partial nephrectomy (PN). The reported incidence varies in the literature, and there are no well-established guidelines for management of UL after PN. The goal of this study is to report the incidence and most common management strategies for UL after PN. For our quantitative synthesis, a systematic review of articles related to UL after PN from April 2010 to April 2020 was performed using PubMed and EMBASE. 475 total records were found, of which 40 reported on post-operative UL. A total of 19,904 cases were included. The overall incidence of UL was 2.8% (554/20,140). UL was most common in open cases (5.01%), followed by laparoscopic (4.40%) and robotic (1.18%) PN. Thirty-one of the included studies reported on management technique for a total of 343 interventions. UL was most frequently managed non-operatively (46.6%). Other management strategies included cystoscopy with ureteral stent placement (39.4%), percutaneous drain placement (8.7%), and percutaneous nephrostomy tube placement (2.3%). Use of nephrectomy, open reconstruction, angioembolization, or ureteroscopic techniques was uncommon (3.1%). Our study revealed that UL is rare after robotic approach to PN. Many reported cases have been managed conservatively. A stepwise management strategy is recommended. Most of these leaks heal with time or with placement of a stent into the ureter after surgery. We found that urine leak is less common with robotic surgery versus open or laparoscopic surgery.