Skip to main content

Jackson-Pratt (JP) Drain

The Jackson-Pratt (JP) drain is the dominant closed-suction, negative-pressure wound drain in reconstructive urology and urogynecology. A perforated silicone drain tube exits the surgical bed through a separate stab incision and connects to a compressible grenade-shaped silicone bulb that generates negative pressure when squeezed and capped — drawing blood, urine, lymph, and serum out of pelvic / retroperitoneal / perineal dead spaces.[1][2] This page is a urology-focused device review; it deliberately excludes the much larger non-urology drain literature (breast, thyroid, orthopaedic, GI). For sibling drains see Blake Drain and Penrose Drain.

History​

Developed by Frederick E. Jackson (a neurosurgeon) and Richard A. Pratt (a surgeon), the JP became one of the two dominant closed-suction drain designs in surgery alongside the Blake drain. It evolved from earlier closed-suction concepts on the principle that active negative pressure in a closed system evacuates postoperative collections more effectively than passive gravity drainage while reducing the bacterial-portal risk of open drains.[2]

Design​

A JP system has three components[1][3]:

1. Intracavitary drain tube (silicone)​

Tube typeProfilePerformance
Flat (fluted)Ribbon with internal channels providing capillary actionLower postoperative pain at multiple time points; clogs more readily in fluid containing debris[4]
Round (perforated)Round silicone with side perforations along the distal lengthHigher in vitro flow rates under serous and purulent conditions; less prone to clogging in debris-rich fluid[3][4]

Both are radiopaque. Typical adult sizes: 7 mm flat / 10 mm round.

2. Connecting tubing​

Flexible silicone exiting the skin through a separate stab incision distinct from the main wound, secured to skin with a suture.

3. Evacuator bulb​

The signature compressible grenade-shaped silicone reservoir, typically 100 mL or 400 mL capacity, with a drainage port / plug at the top. Squeezing the bulb empty and capping the port creates the negative-pressure vacuum that draws fluid through the drain tube.[1][5]

Negative-pressure physics — what surgeons under-appreciate​

Two practical determinants of suction are routinely overlooked in clinical practice[1][3][6]:

Compression direction matters​

Compression methodNegative pressure (cm H₂O)
Side-in (side-to-side)87.4
Bottom-up17.7 (p < 0.001)

Side-in compression generates roughly 5× more negative pressure than bottom-up compression. Patient and nursing education must explicitly teach side-to-side compression.[1][3]

Fill volume rapidly degrades suction​

Negative pressure drops sharply as the bulb fills[1]:

Fluid in bulbNegative pressure (cm H₂O)% of empty-bulb max
0 mL (empty)87.4100%
25 mL72.683%
50 mL41.347%
75 mL37.042%
100 mL (full)35.641%

Evacuators generate only half their maximal negative pressure when ≥ 25% full.[3] The clinical implication is to empty the bulb at ~ 25% fill, not when full — particularly important in early postoperative pelvic / retroperitoneal monitoring after cystectomy, prostatectomy, or upper-tract reconstruction, where output spikes (hemorrhage, urine leak) are exactly when suction efficiency matters most.

Inter-device performance​

Bench testing shows substantial variation across closed-suction bulb-evacuator devices, with maximum negative pressures ranging from −71 to −175 mmHg when reservoirs are empty; pressure decreases as fluid volume increases in all systems. In a 4-device comparison, two of three JP-100 bulbs collected only half the purported 100 mL volume.[5][6]

Use in reconstructive urology and urogynecology​

The JP is the workhorse pelvic / retroperitoneal / perineal closed-suction drain across the WARWIKI atlas. Common applications:

  • Radical / partial cystectomy and urinary diversion — pelvic drainage to monitor for urine leak and hematoma; drain creatinine is the key diagnostic test if leak suspected.
  • Radical prostatectomy and bladder-neck reconstruction — pelvic drain typically placed alongside the vesicourethral anastomosis. See Bladder Neck Reconstruction.
  • Pyeloplasty, ureteroureterostomy, ureteral reimplantation, ileal ureter — retroperitoneal drainage near the anastomosis to detect urine leak and limit urinoma. See Upper Tract Reconstruction.
  • Radical / partial nephrectomy and renal autotransplantation — perinephric drainage.
  • Vesicovaginal / rectovaginal / rectourethral fistula repair — pelvic drainage with explicit vigilance for change in character (stool, urine) signaling persistence or recurrence. See Fistula Repair.
  • Urethroplasty, perineal urethrostomy, posterior urethroplasty (Webster / abdominoperineal) — perineal / pelvic dead-space drainage.
  • Phalloplasty / vaginoplasty — donor and recipient sites.
  • Scrotal / perineal reconstruction (Fournier's debridement, scrotal lymphedema, vulvar reconstruction) — dead-space evacuation under flap or graft.
  • Inguinal lymphadenectomy in penile-cancer reconstructive context — Cochrane review of wound drainage for groin dissection in adults supports closed-suction drainage in this anatomic territory.[7]
  • Augmentation cystoplasty / catheterizable channels — pelvic drainage during bladder-stage healing.
  • Suprapubic catheter as alternative drainage — see Suprapubic Catheter; drains and SPCs serve different purposes (dead-space evacuation vs urinary diversion).

Placement​

  • Exit site: separate stab incision away from the main wound to avoid wound contamination and to allow independent removal.
  • Position: the lowest dependent part of the operative bed where fluid collects (e.g., posterior pelvis behind the bladder neck after RP / cystectomy; perinephric space after pyeloplasty / nephrectomy; periurethral / Retzius space after BNC / VUAS).
  • Fixation: skin suture at the exit site; loop the tubing to prevent traction.
  • Avoid contact with the anastomosis, ureter, or bowel where possible; the perforated portion should sit in the dead space, not against repair sites.

Management​

Daily monitoring​

  • Output volume recorded q8h or per local protocol.
  • Output character — serous, serosanguinous, sanguinous, bilious, urine-like, purulent.
  • Output trajectory — declining trend supports removal readiness; sudden rise warrants workup.

Diagnostic use of drain fluid​

  • Drain fluid creatinine is the cardinal urology-specific test. Drain creatinine ≫ serum creatinine = urinary fistula / leak. This is the principal diagnostic value of a pelvic / retroperitoneal drain after cystectomy, urinary diversion, prostatectomy, ureteral reconstruction, partial nephrectomy, or fistula repair.
  • Drain-to-serum (D/S) creatinine ratio > 1.2 on POD 1 indicates urine leak after partial nephrectomy. In a 140-RAPN cohort, 17% had D/S > 1.2 — those patients had longer drain time (4.2 vs 2.4 d, p = 0.001) and LOS (3.3 vs 2.7 d, p = 0.036). Tumors 4–7 cm had increased risk (OR 2.78). Most RAPN do not require a surgical drain at all.[9]
  • Serum cystatin C can differentiate pseudoazotemia (creatinine reabsorption from intraperitoneal urine extravasation, mimicking AKI) from true azotemia, since cystatin C is not normally excreted into urine — useful when drain output is suspicious for leak after partial nephrectomy or PFUI / pelvic-fracture trauma.[10]
  • Drain culture when output becomes purulent or SIRS develops. The IDSA cautions that drain cultures sent > 3 days after insertion are difficult to interpret because of colonization; send specimens soon after insertion when concern arises.[8]

Removal criteria​

There is no universally standardized removal threshold in urology. A pragmatic synthesis of urologic and adjacent-anatomy evidence supports[3][8]:

  • Output < 30–50 mL / 24 hr of non-bilious, non-purulent, non–urine-like fluid
  • Trajectory clearly declining
  • No imaging evidence of an undrained collection
  • For known or suspected urine leak: drain creatinine equilibrating with serum creatinine confirms resolution before removal

Optimization techniques​

Evidence-based strategies to maximize JP drain efficacy[3][6]:

  1. Squeeze the bulb side-to-side, not bottom-up (~ 5× more negative pressure)
  2. Empty when ≥ 25% full (suction halves at this threshold)
  3. Maximize intracavitary tubing length — increases drainage surface area
  4. Minimize extracavitary tubing length — reduces resistance to flow
  5. Larger-diameter tubing when feasible
  6. Round (perforated) over flat (fluted) when higher flow rates are needed; flat when patient comfort is the priority and debris is unlikely
  7. Strip the tubing when clot obstruction is suspected — relieves obstruction and transiently increases negative pressure[3][6]

Complications​

  • Drain-tract infection / cellulitis — bacterial colonization of drains is common but does not equate to clinical infection. Drain fluid culture interpretation is challenging beyond ~ 3 days of dwell.[8]
  • Drain obstruction / clogging — particularly with flat (fluted) drains in the presence of debris.[4]
  • Premature dislodgment — confused or restless patients; transfers and ambulation.
  • Retained drain / difficult removal — if inadvertently sutured to surrounding tissue or if tissue ingrowth occurs; rarely requires operative retrieval.
  • Pain at exit site and tract.
  • Tissue injury from excessive negative pressure — particularly during aggressive stripping, which generates very high transient pressures.[6]
  • Drain migration — rare but documented, with potential for injury to adjacent structures including ureter and bowel.
  • Prolonged hospitalization — drains are a recurrent driver of LOS across surgical specialties; selective rather than routine drainage is the modern direction.

Antibiotic prophylaxis and drains​

Continuing perioperative antibiotic prophylaxis solely because a drain is in place is not evidence-based. The current consensus is to administer prophylaxis according to standard surgical-site-infection guidance and discontinue at the same interval regardless of drain presence. For pharmacology and reconstructive-urology-specific protocols see Perioperative Antibiotic Prophylaxis and Prosthetic Infection & Biofilm.

Selective vs routine drainage — the modern direction in urology​

Routine drain placement after major uro-oncologic surgery has been progressively replaced by selective, indication-based drainage. The strongest aggregate evidence is the Kowalewski 2020 World J Urol SR/meta of 3,664 patients across radical prostatectomy, cystectomy, and partial nephrectomy — drain omission after RP reduced complications (OR 0.62, 95% CI 0.44–0.87, p = 0.006), with no differences after PN.[11]

Radical prostatectomy​

The Yanagisawa 2023 BJU Int meta of 8 studies / 5,112 RARP patients found no benefit to routine drainage and a decrease in postoperative ileus with drain omission (OR 0.70, 95% CI 0.51–0.91); no difference in any complications, severe complications, or symptomatic lymphocele.[12]

SeriesDesignPatientsKey finding
Araki 2006[13]Prospective552 RRPDrains omitted in 76% with no morbidity increase if anastomosis was watertight on saline bladder fill (~ 50 mL)
Sharma 2007[14]Single-surgeon325Drains omitted in 78% (73% open / 90% robotic)
Musser 2014 (MSK)[15]Cohort651 RALPRoutine drainage did not confer significant complication advantage
Chenam 2018[16]Prospective non-inferiority189 RARPNo-drain not inferior for 90-day overall (17.4% vs 26.8%) or major complications (5.4% vs 5.2%)
Porcaro 2021[17]RCT112 RARP ± ePLNDNo difference Clavien-Dindo (28.9% vs 20.4%, p = 0.254), LOS, readmission
Huang 2021[18]Prospective comparative498No difference in overall / major complications, symptomatic fluid collections, or opioid use
Kirmiz 2020 MUSIC[19]Real-world quality collaborative6,746 RARPs, 115 surgeonsRegular CSD use → LOS > 2 d (OR 1.42) and clinically significant ileus (OR 1.64); no benefit in readmission or prolonged catheterization
Scuderi 2025[20]7-yr cohort1,199 RARPDrain use fell 94% → 18% with no increase in complications; drain placement associated with greater opioid use (OR 1.58); €18,506 / yr cost saved and substantial CO₂-equivalent reduction
Danuser 2013[21]Cohort331 ePLND + RPSymptomatic lymphoceles: 0% with 7-d drainage / 8% with 1-d / 7% open no-drain / 1% robotic no-drain — transperitoneal robotic protective

Practice consensus: drains can be safely omitted after RP / RARP when the urethrovesical anastomosis is watertight (confirmed by saline bladder-fill test). Drains remain appropriate for uncertain anastomotic integrity or difficult bladder-neck reconstruction.

Partial nephrectomy​

SeriesDesignPatientsKey finding
Sánchez-Ortiz 2004[22]Comparative197 PNNo difference closed-suction vs Penrose: prolonged urinary drainage 8.9% vs 5.4%, wound infection 2.4% vs 5.4%
Kriegmair 2016[23]RCT106 open PNNo advantage to drain even with collecting-system violation; drained patients had higher pain (p = 0.01) and prolonged mobilization
Abaza 2013[24]Single-surgeon160 RPNDrains omitted in 93% including 78 with collecting-system entry; only 1.3% small urinomas, all conservative
Beksac 2020[25]Multi-institutional904 RPNNon-routine drain → shorter LOS (IRR 0.72)

Urine leak after PN — incidence and management​

Urine leak occurs in 0.75–18.5% of PN; the robotic approach has the lowest rate (0.75% RAPN vs 3.7% OPN vs 4.9% LPN, p = 0.03 — Mahmud 2025 World J Urol).[26] Risk factors: larger / endophytic / hilar tumors, collecting-system entry, longer warm-ischemia time, reoperative cases.[27][28][29] Management:

  • 44.9% resolve with conservative management (drain + Foley alone).[27]
  • Adding ureteral stent / percutaneous drain / nephrostomy resolves 98.9%.[27]
  • Median time to fistula resolution ~ 43–50 days regardless of management (UroCCR-181 U-Leak — Ghenassia 2026).[30]
  • In a 1,118-PN MSK / Mayo series, 69% of fistulas resolved with no intervention; only 31% required intervention (15% stenting).[31]

Radical cystectomy​

  • Rich 2023 drainless robotic-assisted radical cystectomy with intracorporeal urinary diversion (n = 381): only 5.5% developed urine leak / intra-abdominal infectious collection. Prior radiation therapy was the only significant risk factor (OR 15.12, p = 0.02), with median day of presentation POD 19.[32]
  • When fluid collections do occur, percutaneous drainage is highly successful (technical 100%, clinical 96.9%); collections most often form near the uretero-ileal anastomosis in the right pelvic cavity (80.6%); lymphoceles increase primary clinical-failure risk (OR 22.67).[33]
  • Routine omission cannot yet be broadly recommended after open cystectomy or in irradiated patients.

Nephroureterectomy​

A matched-pair analysis of 108 patients undergoing laparoscopic nephroureterectomy with open distal ureterectomy found drain omission did not increase complications or lymphocele rates and shortened hospital stay (11 vs 8 days).[34]

Kidney transplantation​

Drain use in transplant remains variable.

  • Lakha 2024 SR/meta (4 retrospective studies): no significant reduction in reintervention (OR 0.59) or perinephric collections (OR 0.55) with prophylactic drains.[35]
  • Derweesh 2008 single-center 165 transplants: drains decreased fluid collections (45.2% → 16%, p < 0.05) and DVT.[36]
  • Noor 2023 subcutaneous drains in addition to retroperitoneal drains reduced wound infections 17% → 3% (p = 0.032; multivariable p = 0.001).[37]
  • Kiberd 1999: prolonged wound drainage (> 50 mL/d for > 1 wk) occurred in ~ 16%; associated with delayed graft function (OR 2.8), subsequent lymphocele (OR 5.2), wound infection (OR 27), and + 8.7 hospital days.[38]

Ureteral reimplantation​

A prospective ureteroneocystostomy study (n = 15) found drain fluid urea and creatinine were consistent with serum, not urine — challenging the assumption that drainage fluid contains urine. A pediatric urologist survey: 73.1% routinely placed drains, but 26.5% of those placing them believed they were probably unnecessary.[39]

Iatrogenic urinary tract injury during emergency surgery​

The 2023 WSES guidelines for prevention, detection, and management of iatrogenic urinary tract injuries (IUTI) during emergency digestive surgery formalize the role of drain placement and drain creatinine in detecting and managing these injuries.[40]

Endoscopic management of retained drains​

If a JP drain becomes retained due to tissue ingrowth or inadvertent suturing, endoscopic management has been described — clearing the lumen with a guidewire and releasing external adhesions with a 9.5 Fr rigid ureteroscope passed beside the tube — avoiding open surgical extraction.[41]

NSQIP signal — drain placement is not free​

Talwar 2024 NSQIP analysis comparing drain vs no-drain across nephrectomy, cystectomy, and prostatectomy: drained patients had significantly longer LOS for nephrectomy and prostatectomy.[42]

Decision summary by procedure​

ProcedureRecommendationHeadline evidence
RARP / open RPOmit routinely; place selectively for uncertain anastomosisKowalewski 2020 meta (drain omission ↓ complications); Yanagisawa 2023 RARP meta (drain omission ↓ ileus); Kirmiz 2020 MUSIC; Scuderi 2025 cost / sustainability
Robotic PNOmit routinely; consider for large / complex tumorsAbaza 2013 (93% omission); Beksac 2020 (shorter LOS)
Open PNOmit safely even with collecting-system violationKriegmair 2016 RCT
Robotic RC + intracorporeal diversionEmerging support for omission; prior radiation is the dominant risk factorRich 2023 (5.5% leak / collection rate)
Open RCInsufficient evidence to recommend routine omissionSingle study in Kowalewski meta
NephroureterectomyOmit safelyHagimoto 2023 matched-pair
Kidney transplantVariable; meta shows no benefit but single-center data show fluid-collection reduction; consider closed system in immunosuppressedLakha 2024; Derweesh 2008; Noor 2023

Patient and nursing education​

Discharge with a JP drain in place requires explicit teaching:

  • Compression direction — side-to-side (not bottom-up).
  • Empty when ~ 25% full (not just at end of day).
  • Record volume, color, and consistency at each emptying.
  • Daily showering with soap and water is acceptable for routine drain care.
  • Call for sudden output increase, bright-red blood, foul smell, fever, redness / swelling at exit site, or dislodgment.

See Also​

Blake Drain · Penrose Drain · Suprapubic Catheter · Foley Catheter · Perioperative Antibiotic Prophylaxis · Upper Tract Reconstruction · Fistula Repair · Urinary Diversion

References​

1. Mamuyac EM, Pappa AK, Thorp BD, et al. How much blood could a JP suck if a JP could suck blood? Laryngoscope. 2019;129(8):1806-1809. doi:10.1002/lary.27710

2. Meyerson JM. A brief history of two common surgical drains. Ann Plast Surg. 2016;77(1):4-5. doi:10.1097/SAP.0000000000000734

3. Khansa I, Khansa L, Meyerson J, Janis JE. Optimal use of surgical drains: evidence-based strategies. Plast Reconstr Surg. 2018;141(6):1542-1549. doi:10.1097/PRS.0000000000004413

4. Swartz AL, Azuh O, Obeid LV, et al. Developing an experimental model for surgical drainage investigations: an initial report. Am J Surg. 2012;203(3):388-391. doi:10.1016/j.amjsurg.2011.09.015

5. Whitson BA, Richardson E, Iaizzo PA, Hess DJ. Not every bulb is a rose: a functional comparison of bulb suction devices. J Surg Res. 2009;156(2):270-273. doi:10.1016/j.jss.2009.03.096

6. Grobmyer SR, Graham D, Brennan MF, Coit D. High-pressure gradients generated by closed-suction surgical drainage systems. Surg Infect (Larchmt). 2002;3(3):245-249. doi:10.1089/109629602761624207

7. Thomson DR, Sadideen H, Furniss D. Wound drainage following groin dissection for malignant disease in adults. Cochrane Database Syst Rev. 2014;(11):CD010933. doi:10.1002/14651858.CD010933.pub2

8. Miller JM, Binnicker MJ, Campbell S, et al. Guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2024 update by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM). Clin Infect Dis. 2024;ciae104. doi:10.1093/cid/ciae104

9. Williams RD, Snowden C, Thiel DD. Assessment of perioperative variables that predict the need for surgical drains following robotic partial nephrectomy utilizing quantitative drain creatinine analysis. J Laparoendosc Adv Surg Tech A. 2017;27(1):43-47. doi:10.1089/lap.2016.0417

10. Woldu SL, Matulay JT, Silva MV, et al. Serum cystatin C as a novel marker to differentiate pseudoazotemia in the setting of intraperitoneal urine extravasation. Urology. 2015;85(4):918-920. doi:10.1016/j.urology.2014.12.022

11. Kowalewski KF, Hendrie JD, Nickel F, et al. Prophylactic abdominal or retroperitoneal drain placement in major uro-oncological surgery: a systematic review and meta-analysis of comparative studies on radical prostatectomy, cystectomy and partial nephrectomy. World J Urol. 2020;38(8):1905-1917. doi:10.1007/s00345-019-02978-2

12. Yanagisawa T, Kawada T, Mostafaei H, et al. Role of pelvic drain and timing of urethral catheter removal following RARP: a systematic review and meta-analysis. BJU Int. 2023;132(2):132-145. doi:10.1111/bju.16022

13. 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(6):1241-1247. doi:10.1016/j.eururo.2006.05.026

14. Sharma S, Kim HL, Mohler JL. Routine pelvic drainage not required after open or robotic radical prostatectomy. Urology. 2007;69(2):330-333. doi:10.1016/j.urology.2006.09.044

15. Musser JE, Assel M, Guglielmetti GB, et al. Impact of routine use of surgical drains on incidence of complications with robot-assisted radical prostatectomy. J Endourol. 2014;28(11):1333-1337. doi:10.1089/end.2014.0268

16. Chenam A, Yuh B, Zhumkhawala A, et al. Prospective randomised non-inferiority trial of pelvic drain placement vs no pelvic drain placement after robot-assisted radical prostatectomy. BJU Int. 2018;121(3):357-364. doi:10.1111/bju.14010

17. Porcaro AB, Siracusano S, Bizzotto L, et al. Is a drain needed after robotic radical prostatectomy with or without pelvic lymph node dissection? Results of a single-center randomized clinical trial. J Endourol. 2021;35(6):922-928. doi:10.1089/end.2018.0176

18. Huang MM, Patel HD, Su ZT, et al. A prospective comparative study of routine versus deferred pelvic drain placement after radical prostatectomy: impact on complications and opioid use. World J Urol. 2021;39(6):1845-1851. doi:10.1007/s00345-020-03439-x

19. Kirmiz SW, 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. 2020;23(1):151-159. doi:10.1038/s41391-019-0170-1

20. Scuderi S, Scilipoti P, Nocera L, et al. Perioperative outcomes, environmental impact and economic implications of pelvic drain discontinuation in prostate cancer patients undergoing robot-assisted radical prostatectomy. Urol Oncol. 2025;43(4):271.e1-271.e8. doi:10.1016/j.urolonc.2024.11.022

21. 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(6):963-969. doi:10.1111/j.1464-410X.2012.11681.x

22. Sánchez-Ortiz R, Madsen LT, Swanson DA, Canfield SE, Wood CG. Closed suction or Penrose drainage after partial nephrectomy: does it matter? J Urol. 2004;171(1):244-246. doi:10.1097/01.ju.0000099940.02698.38

23. Kriegmair MC, Mandel P, Krombach P, et al. Drain placement can safely be omitted for open partial nephrectomy: results from a prospective randomized trial. Int J Urol. 2016;23(5):390-394. doi:10.1111/iju.13063

24. Abaza R, Prall D. Drain placement can be safely omitted after the majority of robotic partial nephrectomies. J Urol. 2013;189(3):823-827. doi:10.1016/j.juro.2012.08.236

25. Beksac AT, Okhawere KE, Meilika K, et al. Should a drain be routinely required after transperitoneal robotic partial nephrectomy? J Endourol. 2020;34(9):964-968. doi:10.1089/end.2020.0325

26. Mahmud H, Erlich T, Zilberman DE, et al. Robotic partial nephrectomy is associated with a lower incidence of urine leakage following nephron-sparing surgery for kidney tumors compared to open and laparoscopic approaches. World J Urol. 2025;43(1):254. doi:10.1007/s00345-025-05651-z

27. Blachman-Braun R, Patel M, Loebach L, et al. Urinary leak after partial nephrectomy: insights from a cohort with hereditary, multifocal, and reoperative cases. Urol Oncol. 2025;43(8):470.e11-470.e18. doi:10.1016/j.urolonc.2025.03.013

28. Meeks JJ, Zhao LC, Navai N, et al. Risk factors and management of urine leaks after partial nephrectomy. J Urol. 2008;180(6):2375-2378. doi:10.1016/j.juro.2008.08.018

29. Potretzke AM, Knight BA, Zargar H, et al. Urinary fistula after robot-assisted partial nephrectomy: a multicentre analysis of 1,791 patients. BJU Int. 2016;117(1):131-137. doi:10.1111/bju.13249

30. Ghenassia M, Bernhard JC, Margue G, et al. Management of urinary fistulas after partial nephrectomy: results from the U-Leak study (UroCCR-181). World J Urol. 2026;44(1):157. doi:10.1007/s00345-026-06272-w

31. Kundu SD, Thompson RH, Kallingal GJ, Cambareri G, Russo P. Urinary fistulae after partial nephrectomy. BJU Int. 2010;106(7):1042-1044. doi:10.1111/j.1464-410X.2010.09230.x

32. Rich JM, Geduldig J, Cumarasamy S, et al. Eliminating the routine use of postoperative drain placement in patients undergoing robotic-assisted radical cystectomy with intracorporeal urinary diversion. Urol Oncol. 2023;41(11):457.e1-457.e7. doi:10.1016/j.urolonc.2023.08.015

33. Oh CH. Clinical efficacy and safety of percutaneous drainage for post-operative fluid collection in patients with bladder cancer undergoing radical cystectomy and urinary diversion. Medicine (Baltimore). 2023;102(49):e36488. doi:10.1097/MD.0000000000036488

34. Hagimoto H, Kambe T, Mine Y, et al. Necessity of prophylactic drainage tube in retroperitoneal laparoscopic nephroureterectomy with open distal ureterectomy: a matched-pair analysis. Int J Urol. 2023;30(7):579-584. doi:10.1111/iju.15182

35. Lakha AS, Ahmed S, Hunter J, O'Callaghan J. Prophylactic peri-nephric drain placement in renal transplant surgery: a systematic review and meta-analysis. Transpl Int. 2024;37:13030. doi:10.3389/ti.2024.13030

36. Derweesh IH, Ismail HR, Goldfarb DA, et al. Intraoperative placing of drains decreases the incidence of lymphocele and deep vein thrombosis after renal transplantation. BJU Int. 2008;101(11):1415-1419. doi:10.1111/j.1464-410X.2007.07427.x

37. Noor H, Verdiales C, Moser M. Protective effect of subcutaneous drains on wound infections in kidney transplantation. Transplant Proc. 2023;55(9):2110-2113. doi:10.1016/j.transproceed.2023.08.019

38. Kiberd B, Panek R, Clase CM, et al. The morbidity of prolonged wound drainage after kidney transplantation. J Urol. 1999;161(5):1467-1469.

39. Chow SH, LaSalle MD, Stock JA, Hanna MK. Ureteroneocystostomy: to drain or not to drain. J Urol. 1998;160(3 Pt 2):1001-1003.

40. de'Angelis N, Schena CA, Marchegiani F, et al. 2023 WSES guidelines for the prevention, detection, and management of iatrogenic urinary tract injuries (IUTIs) during emergency digestive surgery. World J Emerg Surg. 2023;18(1):45. doi:10.1186/s13017-023-00513-8

41. Bellman GC, Pardalidas N, Smith AD. Endourologic management of retained surgical drains and nephrostomy tubes. J Endourol. 1994;8(2):115-117. doi:10.1089/end.1994.8.115

42. Talwar A, Bansal A, Knight G, et al. Adverse events of surgical drain placement: an analysis of the NSQIP database. Am Surg. 2024;90(4):672-681. doi:10.1177/00031348231192063