ABSTRACT BACKGROUND Closed suction drain (CSD) placement is common in robot-assisted radical prostatectomy (RARP). Our goal is to quantify outcomes of RARP for patients undergoing RARP by

surgeons who regularly or selectively use CSDs. METHODS Patients undergoing RARP (4/2014−7/2017) were prospectively entered into the Michigan Urological Surgery Improvement Collaborative

(MUSIC) registry. Outcomes included length of stay (LOS) >2 days, >16-day catheterization, 30-day readmission, and clinically significant urine leak or ileus. Retrospective analysis of

each adverse event was performed comparing groups using chi-square tests. RESULTS In all, 6746 RARPs were performed by 115 MUSIC surgeons. CSDs were used in 4451 RARP (66.0%), with wide

> 0.10). Regular CSD use was associated with LOS >2 days (8.4% vs. 6.3%, _p_ = 0.001) and multivariable analyses indicated an odds ratio (OR) of 1.42 (95% CI: 1.12–1.79; _p_ = 0.017)

and increased likelihood of clinically significant ileus (OR: 1.64; CI: 1.14–2.35; _p_ = 0.008). CONCLUSIONS Although there are specific situations in which CSDs are beneficial, e.g.

anastomotic leak or observed lymphatic drainage, regular CSD use during RARP was associated with a greater likelihood of LOS >2 days and clinically significant ileus. Our data suggest

that CSD should be placed selectively rather than routinely after RARP. Access through your institution Buy or subscribe This is a preview of subscription content, access via your

institution ACCESS OPTIONS Access through your institution Subscribe to this journal Receive 4 print issues and online access $259.00 per year only $64.75 per issue Learn more Buy this

article * Purchase on SpringerLink * Instant access to full article PDF Buy now Prices may be subject to local taxes which are calculated during checkout ADDITIONAL ACCESS OPTIONS: * Log in

* Learn about institutional subscriptions * Read our FAQs * Contact customer support SIMILAR CONTENT BEING VIEWED BY OTHERS ASSESSING THE PERIOPERATIVE OUTCOMES OF ABDOMINAL DRAIN OMISSION

AFTER ROBOT-ASSISTED PARTIAL NEPHRECTOMY Article Open access 15 April 2024 COMPARISON OF SENHANCE AND DA VINCI ROBOTIC RADICAL PROSTATECTOMY: SHORT-TERM OUTCOMES, LEARNING CURVE, AND COST

ANALYSIS Article 02 September 2023 CURRENT STATUS ANALYSIS OF THE PREVALENCE AND REGIONAL DISPARITIES OF ROBOT-ASSISTED LAPAROSCOPIC PROSTATECTOMY IN JAPAN USING DIAGNOSIS PROCEDURE

COMBINATION DATA Article Open access 22 October 2024 REFERENCES * Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, van der Kwast T, et al. EAU guidelines on prostate cancer. part 1:

screening, diagnosis, and local treatment with curative intent-update 2013. Eur Urol. 2014;65:124–37. Article  Google Scholar  * Hu JC, Gu X, Lipsitz SR, Barry MJ, D’Amico AV, Weinberg AC,

et al. Comparative effectiveness of minimally invasive vs open radical prostatectomy. JAMA. 2009;302:1557–64. Article  CAS  Google Scholar  * Campbell SC, Klein EA, Levin HS, Piedmonte MR.

Open pelvic lymph node dissection for prostate cancer: a reassessment. Urology. 1995;46:352–5. Article  CAS  Google Scholar  * Musch M, Klevecka V, Roggenbuck U, Kroepfl D. Complications of

pelvic lymphadenectomy in 1,380 patients undergoing radical retropubic prostatectomy between 1993 and 2006. J Urol. 2008;179:923–8. discussion 928−9. Article  Google Scholar  * Pepper RJ,

Pati J, Kaisary AV. The incidence and treatment of lymphoceles after radical retropubic prostatectomy. BJU Int. 2005;95:772–5. Article  Google Scholar  * Capitanio U, Pellucchi F, Gallina A,

Briganti A, Suardi N, Salonia A, et al. How can we predict lymphorrhoea and clinically significant lymphocoeles after radical prostatectomy and pelvic lymphadenectomy? Clinical

implications. BJU Int. 2011;107:1095–101. Article  Google Scholar  * Briganti A, Chun FK, Salonia A, Suardi N, Gallina A, Da Pozzo LF, et al. Complications and other surgical outcomes

associated with extended pelvic lymphadenectomy in men with localized prostate cancer. Eur Urol. 2006;50:1006–13. Article  Google Scholar  * Naselli A, Andreatta R, Introini C, Fontana V,

Puppo P. Predictors of symptomatic lymphocele after lymph node excision and radical prostatectomy. Urology. 2010;75:630–5. Article  Google Scholar  * Gotto GT, Yunis LH, Guillonneau B,

Touijer K, Eastham JA, Scardino PT, et al. Predictors of symptomatic lymphocele after radical prostatectomy and bilateral pelvic lymph node dissection. Int J Urol. 2011;18:291–6. Article 

Google Scholar  * Deture FA. Use of Jackson−Pratt flat suction drain in urologic surgery. Urology. 1979;14:520–1. Article  CAS  Google Scholar  * Walsh PC. Anatomic radical prostatectomy:

evolution of the surgical technique. J Urol. 1998;160(6 Pt 2):2418–24. CAS  PubMed  Google Scholar  * Albala DM, Kevwitch MK, Waters WB. Treatment of persistent lymphatic drainage after

laparoscopic pelvic lymph node dissection and radical retropubic prostatectomy. J Endourol. 1993;7:337–40. Article  CAS  Google Scholar  * Araki M, Manoharan M, Vyas S, Nieder AM, Soloway

MS. A pelvic drain can often be avoided after radical retropubic prostatectomy-an update in 552 cases. Eur Urol. 2006;50:1241–7. discussion 1246−7. Article  Google Scholar  * Patsner B.

Closed-suction drainage versus no drainage following radical abdominal hysterectomy with pelvic lymphadenectomy for stage IB cervical cancer. Gynecol Oncol. 1995;57:232–4. Article  CAS 

Google Scholar  * Merad F, Yahchouchi E, Hay JM, Fingerhut A, Laborde Y, Langlois-Zantain O. Prophylactic abdominal drainage after elective colonic resection and suprapromontory anastomosis:

a multicenter study controlled by randomization. French Associations for Surgical Research. Arch Surg. 1998;133:309–14. Article  CAS  Google Scholar  * Savoie M, Soloway MS, Kim SS,

Manoharan M. A pelvic drain may be avoided after radical retropubic prostatectomy. J Urol. 2003;170:112–4. Article  Google Scholar  * Sharma S, Kim HL, Mohler JL. Routine pelvic drainage not

required after open or robotic radical prostatectomy. Urology. 2007;69:330–3. Article  Google Scholar  * Walsh PC. Radical prostatectomy for localized prostate cancer provides durable

cancer control with excellent quality of life: a structured debate. J Urol. 2000;163:1802–7. Article  CAS  Google Scholar  * Hartanto VH, Han K, Ankem M, Diamond SM. Endoscopic retrieval of

retained Jackson-Pratt drain. Urology. 2001;57:973–4. Article  CAS  Google Scholar  * Chenam A, Yuh B, Zhumkhawala A, Ruel N, Chu W, Lau C, et al. Prospective randomised non-inferiority

trial of pelvic drain placement vs no pelvic drain placement after robot-assisted radical prostatectomy. BJU Int. 2017;121:357–64. * Danuser H, Di Pierro GB, Stucki P, Mattei A. Extended

pelvic lymphadenectomy and various radical prostatectomy techniques: is pelvic drainage necessary? BJU Int. 2013;111:963–9. Article  Google Scholar  * Canes D, Cohen MS, Tuerk IA.

Laparoscopic radical prostatectomy: omitting a pelvic drain. Int Braz J Urol. 2008;34:151–8. Article  Google Scholar  * Musser JE, Assel M, Guglielmetti GB, Pathak P, Silberstein JL, Sjoberg

DD, et al. Impact of routine use of surgical drains on incidence of complications with robot-assisted radical prostatectomy. J Endourol. 2014;28:1333–7. Article  Google Scholar  * Myers SN,

Ghani KR, Dunn RL, Lane BR, Schervish EW, Gao Y, et al. Notable outcomes and trackable events after surgery: evaluating an uncomplicated recovery after radical prostatectomy. J Urol.

2016;196:399–404. Article  Google Scholar  * Su L-M, Gilbert SM, Smith Jr. JA. Laparoscopic and robotic-assisted laparoscopic radical prostatectomy and pelvic lymphadenectomy. In: Wein AJ,

Kavoussi LR, Partin AW, Peters CA, editors. Campbell−Walsh urology. 11th ed. Vol. 3. Philadelphia, PA: Elsevier; 2016. p. 2663–84. * Schaeffer EM, Partin AW, Lepor H. Open radical

prostatectomy. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, editors. Campbell−Walsh Urology. 11th ed. Vol. 3. Philadephia, PA: Elsevier; 2016, p. 2641–62. * Sachedina N, De Los Santos R,

Manoharan M, Soloway MS. Total prostatectomy and lymph node dissection may be done safely without pelvic drainage: an extended experience of over 600 cases. Can J Urol. 2009;16:4721–5.

PubMed  Google Scholar  Download references ACKNOWLEDGEMENTS The corresponding author would like to thank the Betz Family Endowment for Cancer Research for their continued support. Funding

was provided in part by the Spectrum Health Foundation and from Blue Cross Blue Shield of Michigan. We also would like to thank Sabrina Noyes for administrative support. AUTHOR INFORMATION

AUTHORS AND AFFILIATIONS * Michigan State University College of Human Medicine, Grand Rapids, MI, USA Samer W. Kirmiz & Brian R. Lane * Spectrum Health Hospital System, Grand Rapids, MI,

USA Stephen Babitz, Christopher M. Brede & Brian R. Lane * Department of Urology, University of Michigan, Ann Arbor, MI, USA Susan Linsell, Ji Qi, David C. Miller & James E. Montie

Authors * Samer W. Kirmiz View author publications You can also search for this author inPubMed Google Scholar * Stephen Babitz View author publications You can also search for this author

inPubMed Google Scholar * Susan Linsell View author publications You can also search for this author inPubMed Google Scholar * Ji Qi View author publications You can also search for this

author inPubMed Google Scholar * Christopher M. Brede View author publications You can also search for this author inPubMed Google Scholar * David C. Miller View author publications You can

also search for this author inPubMed Google Scholar * James E. Montie View author publications You can also search for this author inPubMed Google Scholar * Brian R. Lane View author

publications You can also search for this author inPubMed Google Scholar CONSORTIA FOR THE MICHIGAN UROLOGICAL SURGERY IMPROVEMENT COLLABORATIVE CORRESPONDING AUTHOR Correspondence to Brian

R. Lane. ETHICS DECLARATIONS CONFLICT OF INTEREST The authors declare that they have no conflict of interest. ADDITIONAL INFORMATION PUBLISHER’S NOTE: Springer Nature remains neutral with

regard to jurisdictional claims in published maps and institutional affiliations. SUPPLEMENTARY INFORMATION SUPPLEMENTAL FIGURE LEGEND SUPPLEMENTARY FIGURE 1 SUPPLEMENTARY TABLE 1

SUPPLEMENTARY TABLE 2 RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Kirmiz, S.W., Babitz, S., Linsell, S. _et al._ Regular vs. selective use of closed

suction drains following robot-assisted radical prostatectomy: results from a regional quality improvement collaborative. _Prostate Cancer Prostatic Dis_ 23, 151–159 (2020).

https://doi.org/10.1038/s41391-019-0170-1 Download citation * Received: 08 May 2019 * Revised: 25 July 2019 * Accepted: 01 August 2019 * Published: 29 August 2019 * Issue Date: March 2020 *

DOI: https://doi.org/10.1038/s41391-019-0170-1 SHARE THIS ARTICLE Anyone you share the following link with will be able to read this content: Get shareable link Sorry, a shareable link is

not currently available for this article. Copy to clipboard Provided by the Springer Nature SharedIt content-sharing initiative