Use of Disposable Punch Biopsy Device to Add Foley Catheter Fenestration to Improve Drainage of Post Radical Prostatectomy Anastomotic Leak

Abstract

CONTEXT CONTEXT Radical prostatectomy (RP) is a major oncologic urological surgery that can have high morbidity if complications arise. Bladder-urethral urine anastomotic leaks (AL) are one of the most common complications and can greatly increase morbidity. To date, there are few resources to manage AL. One management technique is using a Foley catheter with an additional auxiliary drainage port, also known as a fenestrated catheter. This type of auxiliary drainage port allows a low-pressure drainage source that is located near the anastomosis to increase urine drainage from catheter rather than from the AL site. The optimal size and location of this additional drainage port is currently unknown. This experiment evaluated the optimal auxiliary drainage port size and an inexpensive technique to easily construct such a catheter. METHODS METHODS Utilizing different size punch biopsies, auxiliary drainage ports were placed in different size Foley catheters and drainage rates and the structural integrity of the catheter was assessed. RESULTS RESULTS A 3.0 mm punch biopsy located 1.0 cm proximal to the Foley balloon in an 18 French (Fr) catheter was determined to be the optimal size. A 2.0 mm punch biopsy provided significantly less drainage. The 4.0 mm punch biopsy compromised the structural integrity of the catheter. CONCLUSIONS CONCLUSIONS Based on these experimental results, we recommend using a 3.0 mm punch biopsy in an 18 Fr catheter 1.0 cm. proximal to the balloon for an auxiliary drain site in Foley catheter when the anastomosis is not watertight or the surgeon has reason to believe the patient is at higher risk for an AL Factors such as history of pelvic radiation, abnormal anatomy, large prostate, post-surgical hematoma formation, obesity, previous prostatic surgery, difficult anastomosis, blood loss and postoperative urinary tract infection may make use of this type of device more attractive.

A new urinary catheter design reduces in-vitro biofilm formation by influencing hydrodynamics

“…The suggestion to improve drainage through multiple holes on a catheter was first proposed by Thurner-Warwick in 1973 [28]. This concept was developed further by others in the postradical prostatectomy setting or after urethral surgery [29,30]. However, to the authors' knowledge, attempting to ensure complete emptying of the bladder and the prevention of J o u r n a l P r e -p r o o f CAUTI have not been investigated previously; noticeably, the balloon itself has never been modified in any of the mentioned self-retaining catheters.…”

“…This condition typically occurs in FCs, where the bladder is never completely emptied and the flow is intermittent. This situation increases the possibility for bacterial cells to adhere to the surface material and form a biofilm [6,16,[27][28][29][30]. One of the most important criticisms of the FC is that bladder voiding is not complete as the two drainage holes are placed above the balloon, meaning that a certain amount of urine constantly remains around the balloon itself.…”