A Simple but Often Neglected Technique for Managing Prolonged Urinary Leakage from Urethrovesical Anastomosis: The Side-Fenestrated Catheter Approach

Abstract

Urethrovesical anastomotic leakage (UVAL) is a well-documented early complication following radical prostatectomy. While low-volume  leaks are often self-limiting, persistent high-volume leaks (>300 mL/day), where most urine bypasses the catheter, may require invasive  interventions. We report the case of a 58-year-old male with prostate adenocarcinoma who developed high-volume UVAL after  undergoing laparoscopic radical prostatectomy, which was unresponsive to conservative measures. A side-fenestrated catheter was  placed under local anesthesia via cystoscopy on postoperative day 2, leading to rapid resolution of the leak. The patient was subsequently  discharged on postoperative day 4 following drain removal. This case highlights the effectiveness of a simple, minimally  invasive side-fenestrated catheter approach for managing UVAL, offering an alternative to more invasive interventions such as bilateral  percutaneous nephrostomy, suprapubic catheter placement, or even surgical revision of the urethrovesical anastomosis.