Persistent vesicourethral anastomotic leak after radical prostatectomy: a novel endoscopic solution

Area of Science:

• Urology
• Surgical Innovation
• Postoperative Complications

Background:

• Vesicourethral anastomotic leak is a common complication after radical prostatectomy.
• Persistent or high-output urinary leaks may necessitate further intervention.

Purpose of the Study:

• To describe a novel technique for managing prolonged or high-output urinary leaks after radical prostatectomy.
• To evaluate the safety and efficacy of temporary urinary diversion using exteriorized ureteral stents.

Main Methods:

• A technique involving rigid cystoscopy and insertion of ureteral stents (Single J®) through the urethra alongside a Foley catheter.
• Monitoring of urine output and leak volume, with drain removal when leakage decreased to ≤50 ml/day.
• Cystogram to confirm leak resolution before stent removal; time to continence assessed using Kaplan-Meier analysis.

Main Results:

• Seven of 1,480 patients (0.5%) required intervention for anastomotic leaks.
• Stents were in place for an average of 9 days, resolving leaks within 1.8 days.
• Median time to urinary continence recovery was 20 weeks.

Conclusions:

• Temporary urinary diversion with exteriorized ureteral stents is a safe and effective treatment for anastomotic leaks post-prostatectomy.
• While continence recovery might be delayed, long-term urinary function is generally unaffected.