Is a JP drain needed after robotic prostatectomy?

Surgeons are always trying to re-invent the wheel. This is a good, even
great thing. We try to make surgical techniques easier, quicker and less
invasive.

This is a

study out of Miami
claiming that pelvic drains are not required after
open prostate surgery.

There is a current debate in robotic surgery whether a drain is required
after a robotic prostatectomy. Personally, I think a drain is a safe and
easy way to manage a patient. It can prevent serious side effects such as
a urine leak. The drains are easy to remove and do not hurt when they come
out, typically the day after surgery.

From: North
Jersey Center for Urologic Care

I think JP drains can be a very useful thing to use. I know of robotic experts that still use them on every patient. If there are significant urine leaks, they are critical.
I routinely have stopped using them. My experience at Indiana for open prostatectomies was that they were not routinely used. I used them on my first 9 robotic patients and 17 of my first 27 patients.
The only downside of a drain is a small amount of discomfort as it is being removed.
The upside of not having a drain is that I allow my patients to shower the day after surgery if they do not have a drain. The incision I would normally put the drain through is closed with glue.
The risks of infection or a lymphocele from having a drain in place should be minimal as I haven’t seen any yet.
I have used them 9 times in my last 220 operations and have had 1 problem in not leaving it in. One man was doing well and went home after 36 hours and then returned to the hospital after 5 days with a urine leak in which he needed a drain put back in for. I also had one of my 9 patients that had a drain that was removed after 1 day and sent home return after 3 days with a urine leak. This leads me to conclude that drains are good to leave in if you think it will help, but also don’t hesitate to send a patient home with one if there is any concern about a possible urine leak.

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