Prevention and treatment of urethrovesical anastomotic leakage following laparoscopic radical prostatectomy / 第二军医大学学报

ABSTRACT

Objective To search for method for treatment and prevention of urethrovesical anastomotic leakage (PUAL) follownng laparoscopic radical prostatectomy (LRP). Methods Eight (5. 3%) of the 151 laparoscopic radical prostatectomies performed between Jan. 2006 and Jan. 2011 developed PUAL. Running urethrovesical anastomosis was used for 58 patients and traditional suture was used in 93 during LRP. The mean age of the 8 patients was 66 years (ranging 53 to 78 years), the mean preoperative total prostate specific antigen(T-PSA) was 34. 3 ng/ml (ranging 1. 1 to 165. 0 ng/ml). The preoperative Gleason sum was 7 in 2 patients. The mean preoperative Gleason score was 7 (ranging 5 to 9). Pathological stage was T1c nn 5, T2a in 2, and T2c in 1 patient. The mean operation time was 202 min (ranging 60 to 360 min). Several treatments were used, including prolonged retropubic drainage, bladder catheter traction, drain position adjustment, reduction of fluid intake, delayed bladder catheter removal and enhancing nutrition for patients. Patients underwent reoperation using a laparoscopic approach after failure of the initial management. Results PUAL was not observed in LRP cases with running laparoscopic suture technique, which was significantly better than cases with traditional suture method (0 vs 8. 6% [8/93], P<0. 05). Six patients were cured by conservative treatments, 2 patients required reintervention via a laparoscopic approach. The catheters of all patients were removed after a mean of 33 d (ranging 21-43 d). Urethral stricture was not found during a 39-month follow-up(ranging 22to 60 months). Concision Urethrovesical anastomotic leakage can be effectively avoided by running urethrovesical anastomosis; conservative treatment and laparoscopic repair are effective managements to treat PUAL.