Successful wound closure using fibrin glue for intractable neobladder-urethral anastomosis leakage after radical cystectomy and neobladder reconstruction

Abstract

Introduction: Complications of cystectomy and neobladder reconstruction such as anastomotic leakage have been reported. It is a common complication; however, most cases improve conservatively. The use of fibrin glue for fistulas has been reported, but no reports have shown its effectiveness for urinary tract anastomotic leakage. We experienced a case of intractable neobladder-urethral anastomosis leakage after radical cystectomy and neobladder reconstruction, which was effectively managed using fibrin glue.

Case presentation: A 70-year-old man underwent radical cystectomy and ileal neobladder reconstruction for invasive bladder cancer with urothelial carcinoma. After surgery, the urethral catheter fell off and the anastomotic leakage did not improve by adjusting the position of the urethral catheter and percutaneous nephrostomy. We closed the intractable neobladder-urethral anastomotic leakage by injecting fibrin glue and the leakage completely disappeared.

Conclusion: Injecting fibrin glue into anastomotic site can be effective in severe neobladder-urethral anastomosis leakage.

Keywords: anastomotic leakage; cystectomy; fibrin glue; neobladder reconstruction; wound closure.

Fig. 1

(a) CT image showing the leakage. CT scan of horizontal view for the fever examination revealed large amount of fluid collection on the left side of the urethral‐neobladder anastomosis. This may be a lymphocele infection or leakage of urine. (b) Image of leakage in cystography. Cystography reveals a large amount of leakage on the left side of the anastomosis. It reveals a neobladder‐urothelial anastomotic leakage. (c) CT image of severe leakage. CT scan of the coronary view showing urethral catheter falling off. The urethral balloon is falling off from the neobladder in a CT scan of coronary view. It suggests a severe anastomotic dehiscence of suture.

Fig. 2

(a) Image of drainage tube position. We placed a pigtail‐type drainage tube transperineally beside the anastomosis of the neobladder. (b) Image of injecting fibrin glue with a cystoscope. We injected 10 mL of fibrin glue into the large space beside the anastomotic dehiscence from the drainage tube. (c) Image of injecting fibrin glue with a cystoscope. We sprayed 5 mL of fibrin glue around the anastomotic dehiscence from the ureteral catheter using a cystoscope. (d) Schematic diagram of injecting fibrin glue. First, we injected fibrin from the drainage tube. Second, we injected fibrin glue from the ureteral catheter using a cystoscope.

Fig. 3

Cystography image after the disappearance of leakage. The leakage on the left side of the anastomosis has disappeared.