Description of novel robotic early post prostatectomy anastomotic repair technique and institutional outcomes

Objective Vesicourethral anastomotic leak (VUAL) is a known complication following robotic-assisted radical prostatectomy. The natural history of VUAL has been well described and is frequently managed with prolonged catheterization. With increasing emphasis on patient reported outcomes, catheter duration and VUAL are associated with significant short-term quality of life impairment. We aimed to present a case series of our robotic early post-prostatectomy anastomotic repair technique, defined as revision within 6 weeks from index surgery. Methods A single institution prospective database identified eleven patients with VUAL from July 2016 to October 2022 who underwent robotic early post-prostatectomy anastomotic repair by a single surgeon. Patients were diagnosed with VUAL on preoperative CT urogram or CT/fluoroscopic cystogram. Primary outcome was resolution of the anastomotic leak, defined as no contrast extravasation on post-operative cystography. Secondary outcomes included post-repair catheter duration and continence on the last follow-up defined as pad(s) per day. Results Mean time to intervention after robotic-assisted radical prostatectomy was 21.5 days. Eight of the eleven patients (72.7%) had no evidence of extravasation on post-repair cystogram. Range from intervention to first cystogram was 7 days to 20 days. Median catheter duration for those with successful intervention was 10 days. Median catheter duration for those with the leak on initial post-operative cystogram was 20 days. At a mean follow-up time of 24.9 months, eight patients (73%) reported using no pads, and three patients (27%) reported 1 pad per day. Conclusion Management of VUAL has traditionally relied on prolonged catheter drainage and the tincture of time. As the role of robotic reconstruction has been shown to be a viable modality for management of bladder neck contracture, it is important to reconsider prior dogmas of urologic care. Our case series suggests that early repair is safe and has a high success rate. Early robotic intervention gives providers an additional tool in aiding patient recovery.