Minimally invasive treatment of vesicourethral leak after laparoscopic radical prostatectomy

ABSTRACT Objective: to describe our experience with a minimally invasive approach for persistent vesicourethral anastomotic leak (PVAL) after Laparoscopic Radical Prostatectomy (LRP). Methods: from 2004 to 2011, two surgeons performed LRP in 620 patients. Ten patients had PVAL, with initially indicated conservative treatment, to no avail. These patients underwent a minimally invasive operation, consisting of an endoscopically insertion of two ureteral catheters to direct urine flow, fixed to a new urethral catheter. We maintained the ureteral catheters for seven days on average to complete resolution of urine leakage. The urethral catheter was removed after three weeks of surgery. Results: the correction of urine leakage occurred within a range of one to three days, in all ten patients, without complications. There were no stenosis of the bladder neck and urinary incontinence on long-term follow-up. Conclusion: the study showed that PVAL after laparoscopic radical prostatectomy can be treated endoscopically with safety and excellent results.

摘要
目的：阐述我们针对腹腔镜根治性前列腺切除术（Laparoscopic Radical Prostatectomy, LRP）后发生的持续性膀胱尿道吻合口漏（persistent vesicourethral anastomotic leak, PVAL）所采用的微创治疗方案的临床经验。
方法：2004年至2011年间，两位外科医师为620例患者实施了腹腔镜根治性前列腺切除术。其中10例患者出现持续性膀胱尿道吻合口漏，经初始保守治疗无效后，接受了微创手术治疗：在内镜下置入两根输尿管导管以引导尿液流向，并将导管固定于新置入的尿道导管中。我们平均保留输尿管导管7天以实现尿漏完全愈合，术后3周拔除尿道导管。
结果：10例患者的尿漏均在1至3天内得到纠正，未出现任何并发症。长期随访期间无膀胱颈狭窄及尿失禁发生。
结论：本研究表明，腹腔镜根治性前列腺切除术后的持续性膀胱尿道吻合口漏可通过内镜方式治疗，安全性良好且疗效优异。