Introducing a novel technique to remove accidentally stitched or entrapped urethral catheters after radical prostatectomy

Abstract

Introduction: A crucial step during radical prostatectomy is anastomosing the bladder neck to the urethral stump after specimen removal. For this purpose, a Foley catheter is inserted transurethrally to achieve a patent and watertight anastomosis. The catheter should be removed 6-10 days after the procedure to avoid ascending infection and stricture formation. On occasion, catheter removal is not possible due to fixation by one of the anastomotic sutures. In this case, a longer catheterization period may increase the risk of infection and formation of an anastomotic stricture.

Materials and methods: In the present report, we suggest a technique to overcome this problem by using an endoscopic laser dissection of the anastomotic suture. In 2 patients, a 4.8-Fr pediatric ureteroscope was passed through the urethra along the fixated catheter. After carefully inspecting the anastomosis, a laser fiber was brought in direct contact with the responsible suture.

Results and conclusions: By activating the laser, the suture was cut immediately, and the catheter could be removed. Both patients showed no signs of anastomotic leakage or stricture on cystography. Fixation of the catheter after radical prostatectomy is a rare, but bothersome complication, which can compromise the functional outcome of the procedure. Using a pediatric ureteroscope and a laser fiber is an elegant, minimally invasive method to solve this problem. It can be easily and safely performed under local anesthesia in an outpatient setting.