Sodium Fluorescein for Identification of Intraoperative Urine Leaks During Partial Nephrectomy

Abstract

Background: Rates of persistent urine leak after partial nephrectomy are reported in the range of 2-13%, of which many are technically preventable by intraoperative identification and repair of collective system injuries. We describe our technique and institutional experience utilizing intravenous sodium fluorescein, a xanthene die with rapid urinary excretion, at the time of tumor resection during partial nephrectomy for identification of collecting system injury.

Methods: Here, we present a video illustrating the utilization of sodium fluorescein for the intra-operative identification of collecting system injury. We retrospectively reviewed all patients who underwent robot-assisted partial nephrectomy with sodium fluorescein between October 2017 and May 2019 by a single surgeon (KC), and report clinicodemographic and tumor characteristics, as well as rates of post-operative urine leak.

Results: Over the study period, 48 patients underwent robot-assisted partial nephrectomy with intraoperative sodium fluorescein, of which 44 had follow-up data (Table 1). Patients were 66.7% male, had a median age of 65 (interquartile range [IQR] 54-72) years and median body mass index of 27.5 (IQR 24.4-35.5) kg/m². Mean tumor nephrometry score was 7.8 (±1.45), with a mean distance of 3.3 mm (±4.0) from the collecting system. In cases performed with arterial clamping, 5 mL of sodium fluorescein (100 mg/mL) was injected intravenously by anesthesia as the clamp was removed following tumor resection. In cases performed off-clamp, sodium fluorescein was delivered after tumor resection. The video demonstrates three cases where sodium fluorescein aided in the identification and repair of a collecting system leak. There were no recorded urine leaks at time of final follow-up (median 198.6, IQR 20-289 days).

Conclusion: Sodium fluorescein is a simple technique for identification of collecting system injuries at time of partial nephrectomy. With the aid of sodium fluorescein, intra-operative collecting system leaks can be identified and repaired, potentially mitigating postoperative urine leaks and urinomas.