Management of Anastomosis Leakage Post-RALP: A Simple Trick for a Complex Situation

Abstract

A case of 74 years old male patient who underwent RALP with bladder neck reconstruction. Persistent vesicourethral anastomotic leak was seen at cystography. A self-made side fenestrated Foley catheter was used and on the day after, a complete reversal in fluid output between the Foley catheter and the drain was seen.

Use of Disposable Punch Biopsy Device to Add Foley Catheter Fenestration to Improve Drainage of Post Radical Prostatectomy Anastomotic Leak

“…11 Reports as early as 2005 showed post robotic assisted laparoscopic prostatectomy (RALP) anastomotic leaks managed by replacing a standard catheter with fenestrated catheter increased the urine drainage per Foley between 1500-2120 ml/day immediately following catheter changes. 5,6 This finding indicates that urine was flowing out of the catheter rather than into the extra vesical space through the leak.…”

“…4 A less well-known technique includes using an intra-abdominal drain and a fenestrated Foley catheter that consists of a second drainage hole, usually placed on the other side of the inflation balloon from the standard drainage hole. 5 Adding an auxiliary drainage port to the catheter provides any drainage ports on both sides of the balloon a competing drainage site for AL urine flow as this hole is closer to the anastomosis and ureteral orifice than the standard distal catheter holes. 5,6 Fenestrated catheters have been used for decades in the management of AL.…”

“…5 Adding an auxiliary drainage port to the catheter provides any drainage ports on both sides of the balloon a competing drainage site for AL urine flow as this hole is closer to the anastomosis and ureteral orifice than the standard distal catheter holes. 5,6 Fenestrated catheters have been used for decades in the management of AL. Multiple case reports and one randomized control trial have demonstrated that fenestrated catheters can significantly reduce anastomotic leakage post-operatively.…”

“…Multiple case reports and one randomized control trial have demonstrated that fenestrated catheters can significantly reduce anastomotic leakage post-operatively. [5][6][7] To our knowledge, there have not previously been studies evaluating the optimal size fenestration and catheter size to manage AL flow. As such the purpose of this experiment was to evaluate the optimal auxiliary drainage port size and offer an inexpensive technique to easily construct such a catheter.…”

Case – Endoscopic management of severe ventral urine leak post-robot-assisted laparoscopic prostatectomy

“…A self-made fenestration as described by Riikonen et al and Diamand et al is routinely used at our centre and was in this case. 2,3 An intraoperative leak test was performed and was negative. A Jackson-Pratt (JP) drain had been placed to monitor for urine leakage, which was removed on post-operative day (POD) 2 without difficulty.…”