Clinical pathway after robotic nephroureterectomy: omission of pelvic drain with next-day catheter removal and discharge.

Autor: Khemees TA; Department of Urology, The Ohio State University Wexner Medical Center & James Cancer Hospital, Columbus, OH. Electronic address: Tariq.Khemees@osumc.edu., Nasser SM; Department of Urology, The Ohio State University Wexner Medical Center & James Cancer Hospital, Columbus, OH., Abaza R; Department of Urology, The Ohio State University Wexner Medical Center & James Cancer Hospital, Columbus, OH.
Jazyk: angličtina
Zdroj: Urology [Urology] 2014 Apr; Vol. 83 (4), pp. 818-23. Date of Electronic Publication: 2014 Feb 12.
DOI: 10.1016/j.urology.2013.10.078
Abstrakt: Objective: To determine the feasibility of applying a postoperative clinical pathway after robotic nephroureterectomy (RNU) targeting safe omission of a pelvic drain and removal of the bladder catheter on the day after surgery with hospital discharge on postoperative day 1 (POD#1).
Methods: We reviewed a prospectively collected database of all RNUs performed by a single surgeon (R.A.) since institution of our clinical pathway in 2008 that includes pelvic drain omission, bladder catheter removal the morning after surgery, and discharge on POD#1. Patient demographics, and perioperative and postoperative outcomes were evaluated. Ability to adhere to the pathway and achieving the described parameters and whether any resulting complications occurred were determined.
Results: RNU was performed in 29 patients with mean age and body mass index of 69 years (50-90 years) and 30 kg/m(2) (19-41 kg/m(2)), respectively. No patient required a pelvic drain, and 2 were discharged with a catheter. All but 2 patients (93%) were discharged on POD#1. Overall, successful pathway application was achieved in 26 of 29 patients (90%) including no drain, catheter removal on the morning after surgery, and discharge on POD#1. No patient developed urine leak or other complications related to early catheter removal.
Conclusion: Our clinical pathway after RNU allows safe omission of a pelvic drain with early discontinuation of the bladder catheter and discharge on the POD#1 in most patients. To our knowledge, similar pathways have not been previously achieved with nephroureterectomy by any approach, but should be considered by surgeons treating urothelial carcinoma of the upper urinary tract.
(Copyright © 2014 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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