Robotic-assisted laparoscopic pyeloplasty (RALPyelo) has become the standard surgical approach for ureteropelvic junction obstruction due to its high success rates and minimally invasive nature. Traditionally, Jackson-Pratt (JP) drains have been placed postoperatively to monitor for urine leaks or fluid collections. However, emerging evidence suggests that in the absence of intraoperative complications, routine drain use may be unnecessary and could delay discharge or cause patient discomfort [1,2].

This study evaluates the outcomes of robot-assisted laparoscopic pyeloplasty (RALPyelo) in a high output centre, focusing on the necessity and impact of Jackson-Pratt (JP) drain placement, postoperative drain output, and associated complications.

A retrospective analysis of the RALPyelo database (2018–2024) was performed to identify patients who underwent RALPyelo. Data regarding demographics, JP drain insertion, output, dwell duration, reasons for prolonged dwell duration, and complications such as urinoma formation were collected.

A total of 116 patients were included, with a median age of 35 years (interquartile range [IQR]: 23). The cohort consisted of 63 females and 53 males. JP drains were routinely placed in 115 patients (99.1%). Among these, 103 patients (89.6%) had their drains removed on postoperative day 1 (POD1). The median total drain output was 10 mL (IQR: 24 mL). Prolonged drain placement beyond POD1 occurred in 12 patients (10.4%), most commonly due to output exceeding 50 mL (n = 5; 4.3%). Other reasons included unspecified factors (n = 4), fever (n = 2), and postoperative pain (n = 1). Only one patient (0.86%) developed a urinary leak with subsequent urinoma formation.

The findings from this retrospective cohort suggest that the vast majority of patients undergoing robotic-assisted laparoscopic pyeloplasty (RALPyelo) experience minimal postoperative drain output, with nearly 90% of JP drains removed on postoperative day 1. The low median drain output (10 mL) and narrow interquartile range indicate that high-volume drain output is uncommon in this population.

Furthermore, the extremely low incidence of postoperative urinoma (0.86%) implies that the risk of significant urinary leakage is minimal, even when drains are removed early. The small subset of patients requiring prolonged drain placement were largely managed conservatively, and the reasons for delay were mostly benign, including minor increases in drain output, fever, or pain.

These findings support a more selective approach to JP drain use following RALPyelo, particularly in uncomplicated cases [1]. Eliminating routine drain placement in appropriate patients could streamline postoperative care, reduce discomfort, and facilitate earlier discharge, potentially including same-day surgery protocols. However, clinical judgment remains critical, and patient selection criteria for a drainless approach must be established and validated through prospective investigation.

The retrospective analysis of RALPyelo in our high output centre demonstrates a low rate of postoperative drain output beyond 50 ml and an extremely low rate of urinoma formation at 0.86%. This suggests that drainless RALPyelo can be considered in selected patients, potentially facilitating same-day discharges. However, these findings should be validated by prospective studies.

Alanee S, El-Zawahry A, Vemana G, Dynda D, Peabody JO, Menon M. Drainless robotic-assisted laparoscopic pyeloplasty is safe in selected patients. J Endourol. 2017;31(11):1172-1176. [DOI:10.1089/end.2017.0485]
Chandrapal J, Murthy P, Venugopal A, Talathi A, Sabnis R, Desai M.. Jackson-Pratt drain placement in robotic pyeloplasty: Is it really necessary? Urology Annals. 2021;13(2):145–149.