A technique for safe and smooth re-catheterisation of a vesico-urethral anastomosis after radical prostatectomy

Introduction

A vesico-urethral anastomosis over an indwelling catheter is performed during the operation for radical prostatectomy. The catheter is left indwelling for 3–14 days depending upon the surgical technique and preference. The reported incidence of urinary retention on removal of urinary catheter varies from 3% to 10% [1–4]. The incidence of urinary retention is likely to increase with the trend towards early catheter removal. Also, in some patients the catheter may inadvertently slip out of the bladder. These patients may need re-catheterisation in the presence of a raw vesico-urethral anastomosis. A blind catheterisation in this situation may compromise the delicate suturing of the vesico-urethral anastomosis. A safe, smooth and tested method of re-catheterisation of a vesico-urethral anastomosis is described.

Technique

• a) 
  A flexible cystoscope under local anaesthesia is used to visualise the vesico-urethral anastomosis and to enter the bladder. A super stiff guidewire is passed in the bladder. The cystoscope is removed.
• b) 
  A 16 F Foley catheter tip is punctured with the metallic cannula of a 14 G Venflon.
• c) 
  The sharp and rigid back end of the guidewire is passed through the puncture hole at the tip (uncut) of the Foley catheter.
• d) 
  The Foley is threaded over the guidewire and into the urethra. Once the catheter is confirmed to be in the bladder, the guidewire is removed and the catheter balloon is inflated.

Results

We have used this technique for >10 years and we have not experienced any difficulty in catheterisation. The tip puncture method preserves the smooth and rounded tip of Foley catheter and is far better than the method of cutting off the tip of the catheter. We have also used this method of catheterisation in many patients with difficult urethral strictures after dilatation/urethrotomy.