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Technique to control persistent urinary drainage following radical prostatectomy
TECHNIQUE TO CONTROL PERSISTENT URINARY DRAINAGE FOLLOWING RADICAL PROSTATECTOMY RICHARD P ABRAMSON, M.D. JOHN A. FRACCHIA, M.D.
From the Division of Urology, Lenox Hill Hospital, New York, New York
Radical prostatectomy is gaining in acceptance as definitive therapy for patients with organconfined prostatic cancer who are surgical candidates. 1.2 Persistent postoperative urinary extravasation from the vesicourethral anastomosis is occasionally encountered despite intraoperative efforts to attain a mucosa-to-mucosa anastomosis. For this reason we devised a new use of the underwater suction drainage system classitally used to promote extrapleural drainage.3
Material and Methods An underwater drainage system, a wall-suction regulator (standard equipment in many hospital rooms), extension tubing, and sterile water or saline are all that are required to assemble the system. The set up of the system requires approximately ten minutes of the physician’s time (Fig. 1): .
FIGURE 1. Underwater suction drainage system. (A) Foley catheter; (B) drainage tubing; (C) sterile saline; (D) underwater seal; (E) extension tubing; and (F) regulator.
482
UROLOGY
/ MAY 1992
/ VOLUME
XXXIX,
NUMBER
5
1. Approximately
120 cc of sterile fluid are poured directly into the water seal chamber to the indicated line to create an underwater seal. Sterile fluid is similarly introduced into the suction control chamber to the line indicating (negative) 20 cm of water pressure. urethral catheter is then 2. The patient’s connected to drainage tubing which is then attached to the collection chamber. tubing is then connected to 3. Extension both the air vent of the suction control chamber and the regulator which is subsequently attached to wall-suction. 3. The regulator is then adjusted until faint bubbling occurs in the suction chamber. The collection chamber is emptied as needed. The gentle suction is turned on at night before the patient retires and is set to underwater seal during the day while the patient is ambulating.
In our experience, use of this system was rarely required for more than a few days, and all of our patients (N = 18) responded with rapid and significant reductions in drainage. Given the current hospital focus on cost-containment, this technique has proved to be a safe and practical way to significantly shorten the length of hospitalization for this select group of patients. 100 East 77 Street. Room 1177 New York, Nem, York 10021 (DR. ,4RRAMSON) Heferenws
From the Division of Urology, Lenox Hill Hospital, New York, New York
Radical prostatectomy is gaining in acceptance as definitive therapy for patients with organconfined prostatic cancer who are surgical candidates. 1.2 Persistent postoperative urinary extravasation from the vesicourethral anastomosis is occasionally encountered despite intraoperative efforts to attain a mucosa-to-mucosa anastomosis. For this reason we devised a new use of the underwater suction drainage system classitally used to promote extrapleural drainage.3
Material and Methods An underwater drainage system, a wall-suction regulator (standard equipment in many hospital rooms), extension tubing, and sterile water or saline are all that are required to assemble the system. The set up of the system requires approximately ten minutes of the physician’s time (Fig. 1): .
FIGURE 1. Underwater suction drainage system. (A) Foley catheter; (B) drainage tubing; (C) sterile saline; (D) underwater seal; (E) extension tubing; and (F) regulator.
482
UROLOGY
/ MAY 1992
/ VOLUME
XXXIX,
NUMBER
5
1. Approximately
120 cc of sterile fluid are poured directly into the water seal chamber to the indicated line to create an underwater seal. Sterile fluid is similarly introduced into the suction control chamber to the line indicating (negative) 20 cm of water pressure. urethral catheter is then 2. The patient’s connected to drainage tubing which is then attached to the collection chamber. tubing is then connected to 3. Extension both the air vent of the suction control chamber and the regulator which is subsequently attached to wall-suction. 3. The regulator is then adjusted until faint bubbling occurs in the suction chamber. The collection chamber is emptied as needed. The gentle suction is turned on at night before the patient retires and is set to underwater seal during the day while the patient is ambulating.
In our experience, use of this system was rarely required for more than a few days, and all of our patients (N = 18) responded with rapid and significant reductions in drainage. Given the current hospital focus on cost-containment, this technique has proved to be a safe and practical way to significantly shorten the length of hospitalization for this select group of patients. 100 East 77 Street. Room 1177 New York, Nem, York 10021 (DR. ,4RRAMSON) Heferenws