Managing urine leakage following laparoscopic radical prostatectomy with active suction of the prevesical space.

Hora, Milan; Stránský, Petr; Klečka, Jiří; Trávníček, Ivan; Urge, Tomáš; Eret, Viktor; Ferda, Jiří; Petersson, Fredrik; Hes, Ondřej

INTRODUCTION Urine leakage following laparoscopic radical prostatectomy (LRP) is a possible complication that may herald chronic urine incontinence. Intraoperative measures aiming to prevent this is not standardised. AIM Presentation of experience with active suction of the prevesical space in managing postoperative urine leakage. MATERIAL AND METHODS At the Department of Urology, where laparoscopy of the upper abdomen and open RP were performed, a protocol for extraperitoneal LRP was established in 8/2008. Until 5/2011, 154 LRPs have been performed. Urine leakage from a suction drain appeared in 9 cases (5.8%). Permanent active suction (with a machine for Büllae thoracic drainage) of the prevesical space with negative pressure of 7-12 cm of H2O was started immediately. RESULTS Urine leakage started after a mean of 0.9 (0-2) days postoperatively and stopped after a mean of 8.1 (15-42) days. Leakage stopped with only suctioning in 7 cases. In one case, open re-anastomosis was performed on the 7(th) postoperative day (POD). In another case, ineffective active suction was replaced on the 10(th) POD by needle vented suction without effect and the leakage stopped following gradual shortening of the drain up to the 15(th) POD. CONCLUSIONS Active suction of the prevesical space seems to be an effective intervention to stop postoperative urine leakage after laparoscopic radical prostatectomy.