UroToday – Nephroureteral Stent on Suction for Urethrovesical Anastomotic Leak After Robot-Assisted Laparoscopic Radical Prostatectomy

Source Urotoday.com
I found an abstract about a way to manage urinary ascites that can rarely happen after dvP.

Conventional measures, including catheter traction, passive drainage, and needle vented Foley catheter suction, failed. On postoperative day 6 a unilateral nephroureteral stent was placed on intermittent suction.

Placement of one nephroureteral stent on suction device immediately stopped the urinary anastomotic leakage into the peritoneal cavity.

In case of a persistent urinary leak after RALP that fails conservative management, a nephroureteral stent on suction may aid to stop the anastomotic leak.

I have seen this problem a few times in the past 5 years. The best way to manage it, in my opinion, is to place a drain laparoscopically by the surgeon if one does not exist. I found that interventional radiology does not place as large a drain or in as good a place.

While I am placing the drain laparascopically, I also perform a cystoscopy to attempt to place 5 fr ureteral catheters for urinary diversion. I think the most important thing is to push the foley in away from the bladder neck. I think foley traction on the anastamosis is what keeps the opening open.

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