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World Journal of Urology

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01-08-2020 | Nephrectomy | Original Article

Prophylactic abdominal or retroperitoneal drain placement in major uro-oncological surgery: a systematic review and meta-analysis of comparative studies on radical prostatectomy, cystectomy and partial nephrectomy

Authors: K. F. Kowalewski, J. D. Hendrie, F. Nickel, J. von Hardenberg, P. Nuhn, P. Honeck, M. S. Michel, MC Kriegmair

Published in: World Journal of Urology | Issue 8/2020

Abstract

Purpose

To systematically analyze the impact of prophylactic abdominal or retroperitoneal drain placement or omission in uro-oncologic surgery.

Methods

This systematic review follows the Cochrane recommendations and was conducted in line with the PRISMA and the AMSTAR-II criteria. A comprehensive database search including Medline, Web-of-Science, and CENTRAL was performed based on the PICO criteria. All review steps were done by two independent reviewers. Risk of bias was assessed with the Cochrane tool for randomized trials and the Newcastle–Ottawa Scale.

Results

The search identified 3427 studies of which eleven were eligible for qualitative and ten for quantitative analysis reporting on 3664 patients. Six studies addressed radical prostatectomy (RP), four studies partial nephrectomy (PN) and one study radical cystectomy. For RP a reduction in postoperative complications was found without drainage (odds ratio (OR)[95% confidence interval (CI)]: 0.62[0.44;0.87], p = 0.006), while there were no differences for re-intervention (OR[CI]: 0.72[0.39;1.33], p = 0.300), lymphocele OR[CI]: 0.60[0.22;1.60], p = 0.310), hematoma (OR[CI]: 0.68[0.18;2.53], p = 0.570) or urinary retention (OR[CI]: 0.57[0.26;1.29], p = 0.180). For partial nephrectomy no differences were found for overall complications (OR[CI]: 0.99[0.65;1.51], p = 0.960) or re-intervention (OR[CI]: 1.16[0.31;4.38], p = 0.820). For RC, there were no differences for all parameters. The overall-quality of evidence was assessed as low.

Conclusion

The omission of drains can be recommended for standardized RP and PN cases. However, deviations from the standard can still mandate the placement of a drain and remains surgeon preference. For RC, there is little evidence to recommend the omission of drains and future research should focus on this issue.

Review Registration Number (PROSPERO)

CRD42019122885

Available only for authorised users

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Title: Prophylactic abdominal or retroperitoneal drain placement in major uro-oncological surgery: a systematic review and meta-analysis of comparative studies on radical prostatectomy, cystectomy and partial nephrectomy
Authors: K. F. Kowalewski
J. D. Hendrie
F. Nickel
J. von Hardenberg
P. Nuhn
P. Honeck
M. S. Michel
MC Kriegmair
Publication date: 01-08-2020
Publisher: Springer Berlin Heidelberg
Keywords: Nephrectomy
Nephrectomy
Cystectomy
Nephrectomy
Prostatectomy
Prostatectomy
Published in: World Journal of Urology / Issue 8/2020
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-019-02978-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Prophylactic abdominal or retroperitoneal drain placement in major uro-oncological surgery: a systematic review and meta-analysis of comparative studies on radical prostatectomy, cystectomy and partial nephrectomy

Abstract

Purpose

Methods

Results

Conclusion

Review Registration Number (PROSPERO)

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Review Registration Number (PROSPERO)

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