VESICO-URETHRAL ANASTOMOTIC LEAKAGE AFTER RADICAL PROSTATECTOMY. PROGNOSTIC FACTORS AND PRACTICAL APPLICATION

Objective. To determine independent prognostic risk factors for vesicoureteral anastomotic urinary leakage (AUL) and to develop a predictive model.

Material and methods. A retrospective analysis of perioperative parameters was performed in patients with prostate cancer who underwent endovideosurgical radical prostatectomy in the oncology department MH «Neftyanik» in Tyumen from 2020 to 2021. Surgical technique consisted of antegrade radical prostatectomy with priority preservation of sphincter and neck of the bladder and continuous anastomosis. All patients underwent cystography on the 7th day after surgery. Presence of contrast aside from the bladder and urethra was determined as vesicoureteral anastomotic urinary leakage. Multivariate logistic regression analysis was used to identify prognostic factors.

Results. A total of 315 patient medical records were reviewed. AUL was recorded in 42 (13.3%) patients. The average duration of bladder drainage in these patients was 15 days versus 7. In all cases, the anastomotic defect zone included the posterior semicircle. An independent association with AUL was demonstrated by: body mass index (OR=1.083; 95% CI 1.005-1.167), prostate volume (OR=1.025; 95% CI 1.009-1.042), intravesical protrusion of more than 10 mm (OR=3.908; 95% CI 1.206-12.660) and the proportion of positive columns with adenocarcinoma (OR=1.026; 95% CI 1.010-1.043). The obtained data were used to develop a prognostic model. The overall percentage of correct answers of the model was 89.8%. The area under the ROC analysis curve was 0.790 (0.703-0.876). Validation was performed on an independent sample of 86 people.

Conclusion. Body mass index, prostate volume, intravesical protrusion more than 10 mm and the proportion of positive columns with adenocarcinoma are independent factors associated with the risk of AUL. The model we developed can be used to predict and determine individual patient management tactics.

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