Management of urinary fistulas after partial nephrectomy: results from the U-LEAK study (UroCCR-181)

Objectives : Partial nephrectomy can lead to complications such as urinary fistulas, with an incidence ranging from 1 to 17%. Currently, there are no formal guidelines for managing these urinary fistulas. The aim of this study is to assess the time to fistula resolution according to different treatment options. Materials and Methods: The U-Leak study is a retrospective, observational, and multicenter French cohort based on analyses from the UroCCR database. The inclusion period extends from 2009 to 2024, included patients who underwent partial nephrectomy with post-operative urinary fistula. We identified two groups: patients managed interventionally and patients managed without any drainage. The primary objective was to evaluate the time to resolution of urinary fistulas after partial nephrectomy. Results: We included 127 patients, predominantly male (71.7%), with a mean age of 59.4 years. The majority of partial nephrectomies (55.2%) were performed via transperitoneal robotic surgery. Interventional management was applied to 82.4% of patients, 39.5% received a primary double J stent, 17.7% of patients were treated with a bladder catheter combined with a double J and 25.2% received percutaneous drain, bladder catheter or association of two or three treatment. Twenty- five patients required a second intervention. The median time to fistula resolution was 43 days [13.5–81.5] after the first treatment and 48 days [21.5–67.5] after the second. Overall, 79.8% of fistulas resolved after the first intervention. The median time to resolution was 44 days [29.0–69.5] without interventional treatment and 50 days [23.5–87.0] with treatment, with no statistically significant difference between the two groups (p = 0.432). Conclusion: We did not observe a significant difference in the time to resolution of urinary fistulas after partial nephrectomy between patients managed interventionally and those managed without any drainage.