Prillaman Grace E, Tuong Mei, Yeaman Clinton T, Farhi Jacques, Greene Kirsten L
University of Virginia School of Medicine, Charlottesville, VA.
Department of Urology,University of Virginia, Charlottesville, VA.
Urology. 2023 Jan;171:251. doi: 10.1016/j.urology.2022.10.023. Epub 2022 Nov 17.
To describe a method for replacement of a dislodged critical urethral foley catheter following a robotic- assisted laparoscopic radical prostatectomy.
Following robotic-assisted laparoscopic radical prostatectomy (RALP), a bladder drainage via catheter is necessary to allow for proper healing of the urethrovesical anastomosis. In most cases, this is done using a transurethral foley catheter. Early traumatic loss of the urethral catheter following RALP is consider a urologic emergency and can lead to vesicourethral anastomotic urine leak, ileus, infection or abscess, and future anastomotic stenosis. Replacing the urethral catheter in this situation can be difficult even in experienced hands and often requires imaging assistance.
A 53-year-old male with Grade Group 4 (Gleason 4 + 4) prostate cancer underwent an uncomplicated RALP. During his post-operative course, his urethral foley catheter fell out or was traumatically removed three times resulting in disruption of the posterior anastomosis. To replace the urethral catheter and prevent it from being dislodged again, a transabdominal approach under ultrasound and cystoscopic guidance was employed to replace the catheter into the bladder and secure it trans abdominally using a single G-tube safety Pexy T fastener.
This case reports describes a technique used to replace and secure a urethral foley catheter in a patient who suffered from a posterior anastomotic disruption following repeated loss and traumatic removal of his urethral foley catheter during his RALP post-operative course. While replacement of a dislodged urethral foley catheter following a RALP can be challenging, the catheter can safely be placed and secured trans abdominally in these rare but serious situations where the conventional catheter secure devices and patient education alone are not sufficient to prevent removal.
描述一种在机器人辅助腹腔镜根治性前列腺切除术后更换移位的关键尿道 Foley 导管的方法。
在机器人辅助腹腔镜根治性前列腺切除术（RALP）后，通过导管进行膀胱引流对于尿道膀胱吻合口的妥善愈合是必要的。在大多数情况下，这是通过经尿道 Foley 导管完成的。RALP 后早期尿道导管的外伤性丢失被视为泌尿外科急症，可导致膀胱尿道吻合口漏尿、肠梗阻、感染或脓肿，以及未来的吻合口狭窄。即使是经验丰富的医生，在这种情况下更换尿道导管也可能很困难，通常需要影像学辅助。
一名 53 岁、Gleason 评分 4 + 4 的 4 级前列腺癌男性患者接受了无并发症的 RALP。在术后过程中，他的尿道 Foley 导管脱落或被外伤性拔除了三次，导致后吻合口破裂。为了更换尿道导管并防止其再次移位，采用了在超声和膀胱镜引导下的经腹途径将导管置入膀胱，并使用单个 G 型管安全固定 T 形扣经腹固定。
本病例报告描述了一种技术，用于在一名患者中更换并固定尿道 Foley 导管，该患者在 RALP 术后过程中因尿道 Foley 导管反复丢失和外伤性拔除而出现后吻合口破裂。虽然 RALP 后更换移位的尿道 Foley 导管具有挑战性，但在这些常规导管固定装置和单纯患者教育不足以防止导管拔除的罕见但严重的情况下，导管可以经腹安全放置并固定。
