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Jackson-Pratt (JP) Drain

A Jackson-Pratt (JP) system combines a wound drain, connecting tubing and a compressible collection reservoir. Re-expansion of the sealed bulb creates suction. The product family includes perforated and channel drains; “JP” alone does not specify the tube geometry or reservoir capacity.[1]

See Blake Drain for a four-channel silicone design and Penrose Drain for open passive drainage.

History​

The system is named for Frederick E. Jackson and Richard A. Pratt and is one of the two most widely used closed-suction, negative-pressure drains, with the Blake drain. Active suction in a closed system replaced open gravity drainage on the principle that suction evacuates collections more completely and removes the open drain's route for bacteria.[14]

Identify the device​

ComponentWhat to check
Drain tubeFlat or round; perforated or channeled; silicone or another labeled material. Flat JP drains can be perforated: flat does not mean fluted.
SizeFlat drains may be labeled by width in millimeters; round drains by French size. A 10-mm flat drain is not a 10-Fr round drain.
ReservoirCapacity, activation method, compatible connector and whether it uses a bulb or springs. The Cardinal catalog includes 100- and 400-mL bulbs.
Whole assemblyMaterial/allergy labeling, radiopacity, MRI information, securement and the current instructions for the exact product.

Laboratory flow depends on the tube, fluid, reservoir, pressure and position.[1][2]

Tube type and suction​

Bench studies, not clinical trials, describe how tube type and evacuator handling affect flow.

  • Tube type. In a soup model of serous, purulent and debris-laden fluid, the round JP emptied debris-laden fluid faster and with less residual volume, and the flat JP clogged each time.[16] A later in vitro model found higher flow with perforated than with fluted drains, and with longer intracavitary and shorter extracavitary tubing, larger tube diameter, lower fluid viscosity and higher negative pressure.[15]
  • Compression direction. Side-in compression of a 100-mL bulb produced 87.4 cm H2O, compared with 17.7 cm H2O for bottom-up compression (P < 0.0001).[2]
  • Fill volume. Pressure fell to 72.6, 41.3, 37.0 and 35.6 cm H2O with 25, 50, 75 and 100 mL in the bulb.[2] Evacuators generated half their maximal negative pressure when 25% full or more, and the authors advise emptying at about 25% fill.[15]
  • Device variation. Maximal negative pressure with an empty reservoir ranged from 71 to 175 mm Hg across three closed-suction systems, and pressure fell as the reservoir filled.[18] In a four-device comparison, 4 of 6 JP 100-mL bulbs collected only half their stated volume, so bulbs must be emptied well before they are full.[17]
  • Stripping. Stripping the tubing relieves obstruction caused by clot.[15] It also raised drain pressure transiently in all three systems tested and left a residual rise in static pressure in two of them, so forceful stripping is a possible mechanism of tissue injury.[18]

Decide whether a drain is needed​

Specify the intended purpose: evacuating a particular collection, monitoring a suspected leak, or managing selected postoperative dead space.

SettingEvidence that informs the decision
Uncomplicated robot-assisted radical prostatectomyEAU 2026 states it is reasonable to omit the pelvic drain when the anastomosis is watertight at intraoperative testing (narrative statement, no strength rating). The cited trials excluded an intraoperative leak. A 2023 meta-analysis included six studies (1,480 patients), but only two were randomized (299 patients); uncommon serious complications remain imprecisely estimated.[3][4]
Standard partial or radical nephrectomyEAU 2026 states that omitting a drain after standard partial or radical nephrectomy was not associated with higher complication rates and may shorten hospital stay (LE 3; no formal recommendation). Evidence in robotic partial nephrectomy remains limited by the absence of randomized trials.[5]
Kidney transplantationA 2024 review found four retrospective cohorts (2,002 recipients) and no randomized trials. It did not establish a reduction in reintervention or collections. Confidence intervals were wide, and heterogeneity was substantial.[6]
Pelvic lymph-node dissectionEAU states there is no evidence to guide drain use in PLND.[3]
Complex reconstruction, irradiation, urinary diversion or an established leakMake a procedure-specific decision based on tissue quality, repair integrity, contamination, fluid source and the feasibility of rescue drainage.

Evidence by procedure​

Drain omission has been studied mainly in oncologic operations. The findings are relevant to reconstructive practice because they define which drains monitor a leak and which only add morbidity. Most of the data are observational, and each series excluded or handled an intraoperative leak separately.

Radical prostatectomy​

  • A meta-analysis of 3,664 patients (11 studies, six on radical prostatectomy) found fewer postoperative complications without a drain after radical prostatectomy (OR 0.62, 95% CI 0.44 to 0.87). Reintervention, lymphocele, hematoma and urinary retention did not differ. The authors rated the overall evidence quality as low.[19]
  • A meta-analysis of eight studies (5,112 patients) after robot-assisted radical prostatectomy found no difference in any complication (OR 0.89, 95% CI 0.78 to 1.00), severe complications or lymphocele. Omitting the drain was associated with less postoperative ileus (OR 0.70, 95% CI 0.51 to 0.91).[20]
SeriesDesignPatientsFinding
Araki 2006[21]Retrospective consecutive series552 open RRPNo drain in 76% after a bladder fill of about 50 mL without leak. Immediate complications 5% overall, with no difference between groups (6% vs 5%).
Sharma 2007[22]Single-center prospective database325No drain in 78% (73% of open, 90% of robotic cases) when the bladder neck was preserved and the anastomosis was watertight on irrigation. Complications 11% with a drain and 6% without.
Musser 2014[23]Single-surgeon consecutive series, before and after a policy change651 RALPRoutine drainage gave no significant complication advantage.
Chenam 2018[24]Randomized non-inferiority trial, stopped early for slow accrual189 RARP90-day complications 17.4% without a drain and 26.8% with one. Major complications 5.4% and 5.2%. Patients with an intraoperative leak on irrigation were excluded.
Porcaro 2021[25]Single-center randomized trial112 RARP with or without ePLNDClavien-Dindo complications 28.9% with a drain and 20.4% without (P = 0.254). Length of stay and readmission did not differ.
Huang 2021[26]Prospective comparative cohort498No difference in overall or major complications, symptomatic collections or opioid use. Deferral of the drain was chosen intraoperatively in some cases.
Kirmiz 2020[27]Regional quality-collaborative registry6,746 RARP, 115 surgeonsPatients treated by surgeons who regularly used closed-suction drains, compared with those treated by selective users, had higher odds of a stay longer than 2 days (OR 1.42) and clinically significant ileus (OR 1.64). Readmission and prolonged catheterization did not differ.
Scuderi 2025[28]Single-center cohort, 2016 to 20231,199 RARPDrain use fell from 94% to 18%. Complications did not differ (29% vs 28% overall), and drain use was associated with more opioid use (OR 1.58, 95% CI 1.01 to 2.51).
Danuser 2013[29]Randomized drainage duration in open surgery, then consecutive non-drained groups331 with ePLNDSymptomatic lymphocele 0% after 7 days of drainage, 8% after 1 day, 7% with no drain in open surgery and 1% with no drain in transperitoneal robotic surgery.

Drains have been omitted when the urethrovesical anastomosis was watertight on a saline fill test. A drain remains reasonable when anastomotic integrity is uncertain after a difficult bladder-neck reconstruction, an approach suggested by the authors of the Porcaro trial.[25]

Partial nephrectomy​

The meta-analysis found no difference in overall complications (OR 0.99, 95% CI 0.65 to 1.51) or reintervention (OR 1.16, 95% CI 0.31 to 4.38) with or without a drain.[19]

SeriesDesignPatientsFinding
Sánchez-Ortiz 2004[30]Retrospective, drain chosen by surgeon197 partial nephrectomiesClosed suction vs Penrose: prolonged urinary drainage 8.9% vs 5.4%, wound infection or abscess 2.4% vs 5.4%, delayed hemorrhage 2.4% vs 0%. None of the differences was significant.
Kriegmair 2016[31]Randomized trial, open partial nephrectomy106No advantage of a drain, including with collecting-system violation (P = 0.249). Drained patients had more pain (P = 0.01) and longer time to mobilization (P < 0.001).
Abaza 2013[32]Single-surgeon prospective database160 robotic proceduresDrain omitted in 93%, including 78 of 88 patients with collecting-system violation. Two small urinomas (1.3%) appeared more than 2 weeks after surgery in patients without a drain; one was treated with a week of Foley drainage and the other with percutaneous drainage.
Beksac 2020[33]Multi-institutional database904 transperitoneal roboticPatients treated by surgeons who did not routinely drain had a shorter stay (IRR 0.72). Overall complications were 7.33% and 7.82%. These patients had larger tumors.

Drain fluid in partial nephrectomy​

In 124 robotic partial nephrectomies with a postoperative day 1 drain-to-serum creatinine ratio, the authors defined an elevated ratio as above 1.2. It was found in 21 patients (17%) and was associated with longer drain time (4.2 versus 2.4 days, P = 0.001) and stay (3.3 versus 2.7 days, P = 0.036). Masses of 4 to 7 cm were more likely to have an elevated ratio (OR 2.78, P = 0.041). The authors concluded that most robotic partial nephrectomies do not need a drain.[34] The 1.2 cutoff is that study's own definition. It is not a validated leak threshold.

Serum cystatin C is not normally excreted in urine. A case report of pyeloplasty with urine extravasation used a stable cystatin C alongside a raised serum creatinine to separate pseudoazotemia from true azotemia.[35]

Urine leak after partial nephrectomy​

Reported rates range from 0.78% in a 1,791-patient multicenter robotic series to 18.5% after open partial nephrectomy in a 127-patient series.[39][38] In a retrospective review of 785 clinical T1 partial nephrectomies, the leak rate was 0.75% for robotic, 3.7% for open and 4.91% for laparoscopic partial nephrectomy (19 events in total, described by the authors as hypothesis-generating).[36] Robotic approach was also associated with a lower leak risk in a hereditary, multifocal and reoperative cohort (OR 0.376).[37]

Retrospective series associate leak with larger tumor size, endophytic location, hilar location, collecting-system repair, operative and ischemia time, blood loss and repeat partial nephrectomy. The series differ on which factors reach significance: ischemia time was not associated with leak in one and was in two others.[37][38][39][40]

  • Conservative management. In the hereditary cohort, 44.9% of leaks resolved with a drain and Foley catheter alone, and 98.9% resolved with conservative management, ureteral stent, percutaneous drain or nephrostomy tube.[37]
  • Natural history. In a series of 1,118 partial nephrectomies at one center, 52 fistulas (4.6%) occurred, and 69% resolved without intervention. Stenting was the most common intervention (15%).[40]
  • Time to resolution. In the retrospective U-LEAK cohort of 127 patients, median time to resolution was 44 days without interventional treatment and 50 days with it (P = 0.432).[9]

Cystectomy and diversion​

Evidence for drain omission is limited. In a single-center series of 381 drainless robotic cystectomies with intracorporeal diversion, 21 patients (5.5%) had a urine leak or infected intra-abdominal collection, at a median of postoperative day 19.[41] Prior radiation was the only factor associated with the outcome (OR 15.12, 95% CI 1.52 to 156.8), and the wide interval shows how few events there were.[41] The meta-analysis included one cystectomy study and found no difference, and its authors found little evidence to support omission after cystectomy.[19]

When collections form, percutaneous drainage has been effective. In 31 catheter placements among 29 patients, technical success was 100%, primary clinical success 80.6% and final clinical success 96.9%. Of 31 percutaneous drainage catheter placements in 29 patients, 25 (80.6%) were for collections near the uretero-ileal anastomosis in the right pelvis, and lymphocele was associated with primary clinical failure (OR 22.67, 95% CI 1.84 to 279.4).[42]

Nephroureterectomy​

In a propensity-matched analysis of 108 patients undergoing laparoscopic nephroureterectomy with open distal ureterectomy for upper tract urothelial carcinoma, omitting drainage did not change complications or lymphocele rates, and hospital stay was 8 days versus 11 days with a drain (P < 0.0001).[43]

Kidney transplantation​

Data are retrospective and conflict.

  • A meta-analysis of retrospective cohorts found no significant reduction in reintervention (OR 0.59, 95% CI 0.16 to 2.23) or perinephric collections (OR 0.55, 95% CI 0.13 to 2.37) with prophylactic drains.[6]
  • In a single-center series of 165 transplants, drains were associated with fewer fluid collections (45.2% without versus 16.0% with), less lymphocele treatment (19.0% versus 2.5%) and fewer deep vein thromboses (14.3% versus 4.9%). The authors recommended a drain with sirolimus-based immunosuppression.[44]
  • In a nonrandomized series of 112 transplants, wound infection requiring packing occurred in 1 of 36 recipients with an added subcutaneous drain and 13 of 73 without (P = 0.032). The groups differed in BMI and other baseline features.[45]
  • In a prospective series of 392 recipients, prolonged wound drainage (more than 50 mL daily for more than 1 week) was associated with delayed graft function (OR 2.8), lymphocele (OR 5.2), wound infection (OR 27) and 8.7 additional days during the first hospitalization.[46]

Ureteral reimplantation​

In 15 patients aged 7 months to 19 years with intravesical ureteroneocystostomy for reflux, fluid from a closed-suction drain matched serum urea and creatinine, not urine. In a survey of pediatric urologists, 73.1% placed external drains routinely, and 26.5% of those thought the drains were probably unnecessary.[47]

Adverse events of drains in registry data​

In propensity-matched NSQIP data, drained patients had longer stays after nephrectomy and prostatectomy (and after hepatectomy and pancreatectomy). Cystectomy did not differ, and reoperation did not differ for any of the procedures.[49]

Uses in reconstructive urology and urogynecology​

A drain is placed for dead-space evacuation or leak surveillance in the following settings.

  • Cystectomy, partial cystectomy and urinary diversion, for urine leak and hematoma. See Urinary Diversion.
  • Pyeloplasty, ureteroureterostomy, ureteral reimplantation and ileal ureter, as retroperitoneal drainage near the anastomosis. See Upper Tract Reconstruction.
  • Vesicovaginal, rectovaginal and rectourethral fistula repair, where a change in the character of the output (stool, urine) signals persistence or recurrence. See Fistula Repair.
  • Bladder-neck reconstruction and posterior urethroplasty (Webster and abdominoperineal approaches). See Bladder Neck Reconstruction.
  • Perineal urethroplasty and urethrostomy, augmentation cystoplasty and catheterizable channels.
  • Phalloplasty and vaginoplasty (donor and recipient sites), and scrotal, perineal and vulvar reconstruction including Fournier debridement, under flap or graft cover.
  • Renal autotransplantation and partial or radical nephrectomy, as perinephric drainage.

A suprapubic catheter diverts urine and a drain evacuates a space, so one does not substitute for the other.

Placement and daily care​

Keep the drainage segment in the intended space, with a course that avoids kinking, entrapment in closure and pressure on vulnerable structures. Secure the tube without damaging it. Document the location, device, suction prescription and intended removal criteria. Follow the relevant device instructions; the BLAKE/J-VAC instructions explicitly warn about tube injury, occlusion, tissue ingrowth and retained fragments.[7]

For a bulb system, empty and reactivate it using the labeled technique and the patient's taught care plan. A bench experiment with three 100-mL bulbs found that side-to-side compression generated more suction than bottom-up compression, and suction diminished as the bulbs filled. The three-bulb bench study provides no pressure target or 25%-full emptying rule for other reservoirs.[2]

  • Record output volume and character, time interval, patency, suction status and leakage around the tube.
  • Check connections, loss of seal, kinks and displacement when output changes unexpectedly.
  • Escalate new pain, fever, swelling, purulent drainage, increasing bloody output or an abrupt output stop with clinical deterioration. Low output can reflect obstruction or malposition.
  • Do not apply forceful stripping, improvised wall suction or irrigation as a universal troubleshooting step. Use the specific device instructions and an explicit treating-team plan; excessive pressure and handling can damage the tube.[7]

Before discharge, confirm that the patient or caregiver can empty and reactivate the reservoir, keep an output record, protect the exit site and obtain help. Provide a review or removal appointment and clear contact instructions.

Suspected urinary leakage​

Drain-fluid creatinine is a screening aid, not a stand-alone diagnosis or exclusion test. Compare a fresh sample with a contemporaneous serum creatinine and interpret the result alongside the operation, postoperative day, output trend and symptoms.[8]

In a retrospective cystectomy cohort of 340 patients, a drain-to-serum ratio of 1.12 had 68.8% sensitivity and 80.9% specificity for all detected leaks. The ratio was elevated in all 5 ureteral anastomotic leaks but in only 1 of 7 neobladder–urethral anastomotic leaks; with neobladder–urethral leaks excluded, a threshold of 1.18 gave 77.8% sensitivity and 87.6% specificity. These study-derived cutoffs have low positive predictive values; selective imaging in part of the cohort limits their application to other GU operations. A near-serum value can miss a localized collection or a leak that does not reach the drain.[8]

Persistent suspicion requires assessment of the urinary tract and targeted imaging appropriate to the reconstruction. Verify catheter or stent function and whether the collection itself is adequately drained.

The 2026 U-LEAK multicenter observational study did not demonstrate faster resolution with intervention than surveillance after partial nephrectomy. Treatment selection was not randomized, and adjustment was insufficient. It does not justify withholding diversion or drainage when clinically needed.[9]

Cultures and antibiotics​

Obtain an aseptic fluid specimen when the clinical question warrants culture. Fluid from an old collection bag, a dressing or a colonized drain can mislead. IDSA/ASM notes that organisms recovered from drains present for more than three days may represent colonization and be difficult to interpret. Fluid testing from an open or gravity-drained system depends on specimen quality and collection technique.[10]

Do not prolong surgical antibiotic prophylaxis solely because a wound drain remains. WHO makes this a conditional recommendation based on low-quality evidence. Treatment of an established infection is a separate decision.[11]

Removal​

Reassess the original indication daily. Remove the drain when clinically appropriate, considering output trend and character, the procedure, ongoing leakage, infection and any remaining collection. There is no validated universal 30–50 mL/day rule for every reconstruction, and imaging is not mandatory before every uncomplicated drain removal.[11]

The 2014 Cochrane review found no eligible randomized trials. The later MAMBO prospective, nonrandomized study (141 women; 251 groins) associated volume-controlled drainage with fewer lymphoceles than fixed day-five removal after vulvar-cancer inguinofemoral lymphadenectomy. Substantial protocol deviations and the specific operation limit generalization.[12][13]

Release suction before removal and remove securement according to the device and local procedure. If there is unexpected resistance, stop and assess for entrapment or tissue ingrowth rather than pulling harder. Inspect the removed device for completeness and document removal.[7]

Refractory lymphatic leak​

When drain output does not fall with prolonged drainage, interventional radiology can perform intranodal lymphangiography with embolization rather than continued drain management alone. An inguinal node is accessed under ultrasound guidance and injected with an oil-based iodinated contrast agent to opacify the lymphatic system; an identified leak is then embolized. In a retrospective series of 20 patients (15 pelvic, 5 retroperitoneal iatrogenic lymphoceles) who underwent 22 intranodal lymphangiograms, leaks were identified in 19/22 studies (86.4%). Median catheter output before intervention was 210 mL/day; among the 18 embolizations, median output was 20 mL/day three days afterward and median time from lymphangiography with embolization to catheter removal was 6 days. No recurrence requiring redrainage was observed during symptom-based follow-up (median 3 months); four patients had minor complications of low-grade fever or lower-limb edema.[50]

Complications​

  • Drain-tract infection or cellulitis. Bacterial colonization of drains is common and does not equal clinical infection. Culture interpretation becomes difficult after about 3 days of dwell.[10]
  • Obstruction. Clot and debris can block the tube, and flat drains clogged in a debris-laden bench model.[16]
  • Dislodgment. Confusion, restlessness, transfers and ambulation are the usual settings.
  • Retained or difficult removal. A drain sutured to surrounding tissue or invaded by tissue can resist removal. In a pig model and one patient, a retained JP drain was freed endoscopically by clearing the lumen with a guidewire and releasing external adhesions with a 9.5-Fr rigid ureteroscope passed beside the tube.[48]
  • Exit-site and tract pain. Drained patients had more pain than undrained patients in a randomized open partial nephrectomy trial.[31]
  • Tissue injury from suction. Forceful stripping generates high transient pressures.[18]
  • Migration. Migration is uncommon, but it can injure adjacent structures such as the ureter or bowel.
  • Longer stay. Drains were associated with longer stay after nephrectomy and prostatectomy in registry data.[49]

Discharge teaching​

Bench data support teaching side-to-side compression and emptying the bulb by about 25% fill.[2][15] The patient records the volume, color and character of the output at each emptying and calls for a sudden increase in output, bright red blood, foul odor, fever, redness or swelling at the exit site, or dislodgment.

References​

1. Cardinal Health. Jackson-Pratt Wound Drains: product catalog. 2021. Manufacturer catalog (distributor-hosted copy).

2. 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.

3. European Association of Urology. Prostate Cancer Guidelines. 2026. Treatment, section 6.2.2.e, Pelvic drain. Guideline.

4. Ma J, Chang Y, Xu W, et al. Pelvic drain placement after robot-assisted radical prostatectomy: meta-analysis. BJS Open. 2023;7(6):zrad143. doi:10.1093/bjsopen/zrad143.

5. European Association of Urology. Renal Cell Carcinoma Guidelines. 2026. Section 7.2.3.e, Placement of a drain. Guideline.

6. 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.

7. Ethicon. BLAKE Silicone Drains; J-VAC Closed Wound Drainage System instructions for use. 2021. Manufacturer brochure and instructions.

8. Regmi SK, Bearrick EN, Hannah PTF, et al. Drain fluid creatinine-to-serum creatinine ratio as an initial test to detect urine leakage following cystectomy: a retrospective study. Indian J Urol. 2021;37(2):153–158. doi:10.4103/iju.IJU_396_20.

9. 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;44:157. doi:10.1007/s00345-026-06272-w.

10. Miller JM, Binnicker MJ, Campbell S, et al. Guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2024 update by IDSA and ASM. Clin Infect Dis. 2024. Interventional Radiology and Drain Devices. doi:10.1093/cid/ciae104.

11. World Health Organization. Global Guidelines for the Prevention of Surgical Site Infection. 2nd ed. 2018. Section 4.26: antibiotics and drain removal and Web Appendix 27: systematic review.

12. 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.

13. Pouwer AW, Hinten F, van der Velden J, et al. Volume-controlled versus short drainage after inguinofemoral lymphadenectomy in vulvar cancer patients: a Dutch nationwide prospective study. Gynecol Oncol. 2017;146(3):580–587. doi:10.1016/j.ygyno.2017.06.031.

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

15. 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.

16. 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.

17. 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.

18. 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.

19. 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.

20. 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.

21. 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.

22. 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.

23. 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.

24. 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.

25. 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.

26. 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.

27. 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.

28. 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.

29. 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.

30. 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.

31. 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.

32. 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.

33. 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.

34. 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.

35. 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.

36. 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.

37. 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.

38. 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.

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