Management of vesico-urethral anastomosis disruption after radical prostatectomy.

BACKGROUND/AIMS: Disruption of vesico-urethral anastomosis is a complication which can have dramatic results on the post-operative quality of life of the patient who has had radical prostatectomy. We present our own experience of this complication and discuss the aetiology, treatment and outcome with reference to published data on the subject. We suggest means by which to prevent this complication.

METHODS

A retrospective notes review was performed on our own series of 4 patients with disruption of the vesico-urethral anastomosis after radical prostatectomy. A literature review was performed on the subject.

RESULTS

We explore ways of managing this complication based on our own series and the published data. We find that urethral disruption is most often significant if a blind attempt at catheter reinsertion by an inexperienced doctor is made. Replacement over a guide-wire using a flexible cystoscope is reasonable provided a significant distraction injury has not already occurred.

CONCLUSIONS

Replacement of the urethral catheter which has fallen out/is blocked should be done using cystoscopic guidance, if it needs to be replaced at all. We find that outcome, in terms of urinary continence, is better if, having sustained a significant disruption of the anastomosis, immediate surgical revision of anastomosis is performed.