Total Urethrovesical Anastomotic Disruption: a Video Case Report

This case involved a 62 year old patient who had robot-assisted laparoscopic radical prostatectomy (RALRP) for biopsy-diagnosed Gleason 4+3 prostate cancer. He presented to the hospital on day 8 post RALRP for routine catheter removal. However, he reported feeling unwell for the past 2 days and passing dark blood-stained urine with debris. These symptoms were preceded by an episode of “coughing fits”. A pelvic computed tomography scan was done which showed disruption of the anastomosis with the catheter lying within the contrast-filled prostatic cavity. The patient was returned to operating theatre for robot-assisted (Da Vinci Si HD) reconstruction of urethrovesical anastomosis. Intra-operatively, complete urethrovesical anastomosis disruption was evident, and there appeared to be an anastamotic suture breakage and unravelling of the monofilament suture. The repair process was difficult due to tissue fragility. The anastomosis was repaired with monofilament suture by Van Velthoven style; reinforcements with simple interrupted suture were made at 2 o’clock, 5 o’clock, 7 o’clock and 10 o’clock. Patient recovered well post-operatively but anastomotic leak was persistent. The urinary catheter was kept in for 4 weeks total after which cystogram showed water-tight healing.