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An Alternative Method of Postoperative Urinary Drainage
Vol. 108, September Printed in U.S.A.
THE JOURNAL OF UROLOGY
Copyright © 1972 by The Williams & Wilkins Co.
AN ALTERNATIVE METHOD OF POSTOPERATIVE URINARY DRAINAGE BARTON TANENBAUM, SIDNEY R. WEINBERG
AND
STEPHEN M. LAZARUS
From the Division of Urology, Jewish Hospital and Medical Center of Brooklyn, Brooklyn, New York
A Penrose drain is the usual method of postoperative drainage of the urinary tract. However, with this method there is constant seepage of urine on the skin, leading to irritation and sometimes excoriation. This complication is most pronounced in cases requiring long-term drainage. To avoid this complication, we have begun using a large hemovac portable continuous suction apparatus for postoperative drainage in addition to the rubber dam drain. Hemovac drainage is widely used following several general surgical and orthopedic procedures to drain off the serous fluid accumulation, to decrease dead space and prevent subsequent infection. The constant urinary drainage which follows operation on the urinary tract provides an ideal situation for the use of closed continuous drainage. The plastic tubing attached to the hemovac generally remains in place less than 2 weeks (usually 1 week) and is non-reactive. The constant flow of urine prevents clogging of the multi-eyed tubing. The suction is constant, preventing urine accumulation and subsequent infection. When necessary, urinary output can be measured. Serous drainage is also siphoned off until lymphatic channels heal. Instead of suction pumps which immobilize a patient, the hemovac apparatus can be worn or carried, permitting easy ambulation. The patient is kept dry and does not require frequent dressing changes.
pelvic junction stricture of the right kidney. Hemovac suction was used. Postoperative urinary drainage was nil. Followup IVP revealed prompt function and decrease of the hydronephrosis. Case 3. E. V., a 37-year-old Puerto Rican woman, had a left stagho:rn calculus and numerous calculi of the left ureter. She underwent partial nephrectomy, pyelolithotomy and ureterolithotomy. The renal pelvis was left open and urinary drainage was minimal. Ten days postoperatively the hemovac was removed. The incision healed well. No skin irritation was present. Followup IVP disclosed good function with no evidence of stone formation after 6 months. Case 4. S. I. B., a 52-year-old white woman, underwent a left dismembered pyeloplasty for a ureteropelvic junction stricture. Penrose drainage was nil. The hemovac was removed after 7 days. The incision was well healed. Postoperative IVP revealed good function with reduction of the previous hydronephrosis.
CASE REPORTS
Case 1. M. D., a 31-year-old Puerto Rican woman, was found to have a ureteropelvic junction stricture of the left kidney. Pyeloplasty without intubation was performed. Active drainage persisted for 5 days, siphoned off by hemovac drainage. The hemovac was removed 7 days postoperatively. Dressings were changed daily and were never urine soaked. The incision was well-healed and free of irritation at discharge from the hospital. Followup excretory urogram (IVP) showed good function and a good result. Case 2. D. C., a 47-year-old white woman, underwent a pyeloplasty without intubation for a ureteroAccepted for publication December 22, 1971.
470
COMMENT
It is our practice to use a Penrose drain which emerges via the angle of the incision, in addition to the hemovac. The tubing of the hemovac is placed in the operative site in the retroperitoneum in a dependent position and brought out through a stab wound. Since we encounter no difficulty with the hemovac, the rubber tissue drain is removed after 5 days. The rubber drain is an added safety factor. Since the hemovac works satisfactorily in most cases, the rubber drain is removed earlier to prevent a large sinus tract. Generally the hemovac is removed 2 days following total cessation of drainage which indicates contiguous healing of the urinary tract. We have encountered neither difficulties nor complications with this drainage system. The patient is comfortable and dry. SUMMARY
An alternative method of postoperative urinary drainage utilizing a large hemovac apparatus is described. Results have been satisfactory to both patient and physician.
THE JOURNAL OF UROLOGY
Copyright © 1972 by The Williams & Wilkins Co.
AN ALTERNATIVE METHOD OF POSTOPERATIVE URINARY DRAINAGE BARTON TANENBAUM, SIDNEY R. WEINBERG
AND
STEPHEN M. LAZARUS
From the Division of Urology, Jewish Hospital and Medical Center of Brooklyn, Brooklyn, New York
A Penrose drain is the usual method of postoperative drainage of the urinary tract. However, with this method there is constant seepage of urine on the skin, leading to irritation and sometimes excoriation. This complication is most pronounced in cases requiring long-term drainage. To avoid this complication, we have begun using a large hemovac portable continuous suction apparatus for postoperative drainage in addition to the rubber dam drain. Hemovac drainage is widely used following several general surgical and orthopedic procedures to drain off the serous fluid accumulation, to decrease dead space and prevent subsequent infection. The constant urinary drainage which follows operation on the urinary tract provides an ideal situation for the use of closed continuous drainage. The plastic tubing attached to the hemovac generally remains in place less than 2 weeks (usually 1 week) and is non-reactive. The constant flow of urine prevents clogging of the multi-eyed tubing. The suction is constant, preventing urine accumulation and subsequent infection. When necessary, urinary output can be measured. Serous drainage is also siphoned off until lymphatic channels heal. Instead of suction pumps which immobilize a patient, the hemovac apparatus can be worn or carried, permitting easy ambulation. The patient is kept dry and does not require frequent dressing changes.
pelvic junction stricture of the right kidney. Hemovac suction was used. Postoperative urinary drainage was nil. Followup IVP revealed prompt function and decrease of the hydronephrosis. Case 3. E. V., a 37-year-old Puerto Rican woman, had a left stagho:rn calculus and numerous calculi of the left ureter. She underwent partial nephrectomy, pyelolithotomy and ureterolithotomy. The renal pelvis was left open and urinary drainage was minimal. Ten days postoperatively the hemovac was removed. The incision healed well. No skin irritation was present. Followup IVP disclosed good function with no evidence of stone formation after 6 months. Case 4. S. I. B., a 52-year-old white woman, underwent a left dismembered pyeloplasty for a ureteropelvic junction stricture. Penrose drainage was nil. The hemovac was removed after 7 days. The incision was well healed. Postoperative IVP revealed good function with reduction of the previous hydronephrosis.
CASE REPORTS
Case 1. M. D., a 31-year-old Puerto Rican woman, was found to have a ureteropelvic junction stricture of the left kidney. Pyeloplasty without intubation was performed. Active drainage persisted for 5 days, siphoned off by hemovac drainage. The hemovac was removed 7 days postoperatively. Dressings were changed daily and were never urine soaked. The incision was well-healed and free of irritation at discharge from the hospital. Followup excretory urogram (IVP) showed good function and a good result. Case 2. D. C., a 47-year-old white woman, underwent a pyeloplasty without intubation for a ureteroAccepted for publication December 22, 1971.
470
COMMENT
It is our practice to use a Penrose drain which emerges via the angle of the incision, in addition to the hemovac. The tubing of the hemovac is placed in the operative site in the retroperitoneum in a dependent position and brought out through a stab wound. Since we encounter no difficulty with the hemovac, the rubber tissue drain is removed after 5 days. The rubber drain is an added safety factor. Since the hemovac works satisfactorily in most cases, the rubber drain is removed earlier to prevent a large sinus tract. Generally the hemovac is removed 2 days following total cessation of drainage which indicates contiguous healing of the urinary tract. We have encountered neither difficulties nor complications with this drainage system. The patient is comfortable and dry. SUMMARY
An alternative method of postoperative urinary drainage utilizing a large hemovac apparatus is described. Results have been satisfactory to both patient and physician.