Allen Aubrey, Wynberg Jason, Walton Eric
Detroit Medical Center Department of Urology, PGY2 Resident.
Specialist in Chief, Detroit Medical Center Department of Urology.
Spartan Med Res J. 2019 Mar 4;3(3):7024. doi: 10.51894/001c.7024.
Radical prostatectomy (RP) is a major oncologic urological surgery that can have high morbidity if complications arise. Bladder-urethral urine anastomotic leaks (AL) are one of the most common complications and can greatly increase morbidity. To date, there are few resources to manage AL. One management technique is using a Foley catheter with an additional auxiliary drainage port, also known as a fenestrated catheter. This type of auxiliary drainage port allows a low-pressure drainage source that is located near the anastomosis to increase urine drainage from catheter rather than from the AL site. The optimal size and location of this additional drainage port is currently unknown. This experiment evaluated the optimal auxiliary drainage port size and an inexpensive technique to easily construct such a catheter.
Utilizing different size punch biopsies, auxiliary drainage ports were placed in different size Foley catheters and drainage rates and the structural integrity of the catheter was assessed.
A 3.0 mm punch biopsy located 1.0 cm proximal to the Foley balloon in an 18 French (Fr) catheter was determined to be the optimal size. A 2.0 mm punch biopsy provided significantly less drainage. The 4.0 mm punch biopsy compromised the structural integrity of the catheter.
Based on these experimental results, we recommend using a 3.0 mm punch biopsy in an 18 Fr catheter 1.0 cm. proximal to the balloon for an auxiliary drain site in Foley catheter when the anastomosis is not watertight or the surgeon has reason to believe the patient is at higher risk for an AL Factors such as history of pelvic radiation, abnormal anatomy, large prostate, post-surgical hematoma formation, obesity, previous prostatic surgery, difficult anastomosis, blood loss and postoperative urinary tract infection may make use of this type of device more attractive.
根治性前列腺切除术（RP）是一种主要的肿瘤泌尿外科手术，如果出现并发症，其发病率可能很高。膀胱尿道尿液吻合口漏（AL）是最常见的并发症之一，会显著增加发病率。迄今为止，处理AL的资源很少。一种处理技术是使用带有额外辅助引流口的Foley导尿管，也称为带孔导尿管。这种类型的辅助引流口可提供一个位于吻合口附近的低压引流源，以增加从导尿管而非AL部位的尿液引流。目前尚不清楚这个额外引流口的最佳尺寸和位置。本实验评估了最佳辅助引流口尺寸以及一种易于构建此类导尿管的廉价技术。
利用不同尺寸的穿刺活检孔，在不同尺寸的Foley导尿管上设置辅助引流口，并评估引流速率和导尿管的结构完整性。
在18法式（Fr）导尿管中，位于Foley球囊近端1.0 cm处的3.0 mm穿刺活检孔被确定为最佳尺寸。2.0 mm穿刺活检孔的引流明显较少。4.0 mm穿刺活检孔损害了导尿管的结构完整性。
基于这些实验结果，我们建议当吻合口不严密或外科医生有理由认为患者发生AL的风险较高时，在18 Fr导尿管中，于球囊近端1.0 cm处使用3.0 mm穿刺活检孔作为Foley导尿管的辅助引流部位。盆腔放疗史、解剖结构异常、前列腺体积大、术后血肿形成、肥胖、既往前列腺手术史、吻合困难、失血和术后尿路感染等因素可能会使这种装置更具吸引力。
