# An Alternative Approach to Managing Urethrovesical Anastomotic Leakage After Robot-Assisted Laparoscopic Radical Prostatectomy: External Urethral Meatus Catheter Fixation

## TL;DR

A new technique for managing urinary leakage after prostate surgery is described, involving securing the urethral catheter at the external urethral meatus.

## Contribution

A novel catheter fixation method at the external urethral meatus is proposed as an effective alternative for managing anastomotic urinary leakage.

## Key findings

- Fixing the urethral catheter at the external urethral meatus resolved leakage and abdominal pain in a patient with failed standard management.
- Standard AUL management strategies were ineffective in this case, necessitating an alternative approach.
- The proposed technique offers a simple and effective solution for managing anastomotic urinary leakage post-surgery.

## Abstract

A 46-year-old male presented with a prostate-specific antigen (PSA) level of 4.27 ng/mL. MRI identified a Prostate Imaging Reporting and Data System category 4 lesion in the right peripheral zone. Prostate biopsy confirmed adenocarcinoma with a Gleason score of 3+3. The patient was diagnosed with localized prostate cancer (cT2aN0M0) and underwent robot-assisted laparoscopic radical prostatectomy via a transperitoneal approach. Postoperatively, urine was immediately observed through the intraperitoneal drain. To address the anastomotic urinary leakage (AUL), gentle traction of the urethral catheter was applied and secured with abdominal tape. However, on postoperative day 8, the patient developed severe abdominal pain. A CT scan revealed fluid accumulation around the bladder, liver, and spleen, along with ventral migration of the drain, indicating inadequate urine drainage. Standard AUL management strategies had proven ineffective, complicating the case. Ultimately, fixation of the urethral catheter at the external urethral meatus using adhesive tape successfully resolved the leakage and alleviated the abdominal pain. This simple technique may offer an effective alternative for managing AUL.