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First report of urinary endoscopic vacuum therapy

For large bladder defect after abdomino-perineal excision of the rectum. Video paper

Erstbeschreibung einer endoskopischen Vakuumtherapie der ableitenden Harnwege

Bei großem Harnblasendefekt nach abdomino-perinealer Rektumexstirpation. Videobeitrag

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Abstract

Purpose

The technique of active urinary endoscopic vacuum therapy (uEVT) is described. The surgical technique is demonstrated in detail with the help of a video of the operation, which is available online. Vesical fistulas are a rare complication following rectal surgery. The EVT technique is a novel method for the treatment of gastrointestinal leakage. This endoscopic procedure has been adapted to treat a large bladder defect after abdomino-perineal resection of the rectum with urine flowing out of the perineal wound.

Materials and methods

A new open-pore film drainage (OFD) catheter with an external diameter of only a few millimeters was developed and constructed from a very thin open-pore double-layered film and a drainage tube. The OFD was inserted into the bladder by means of flexible endoscopy and channeled out through a suprapubic incision. Continuous suction was applied with an electronic vacuum pump to actively drain the urine completely. A passive catheter drainage of urine from the renal pelvis via a transurethral single J stent was carried out simultaneously during the complete duration of treatment. The healing process was monitored during and after therapy via intravesical endoscopy.

Results

The application of continuous negative pressure via the OFD resulted in total collapse of the bladder. The urine in the bladder was actively and permanently drained through the OFD. Urine leakage from the perineal wound stopped immediately after induction of suction. The bladder defect healed after 18 days of treatment with uEVT. After therapy and removal of the catheters, the patient had normal micturition.

Conclusion

A novel small-bore OFD was developed for EVT. The OFD technique allows for endoscopic application of negative pressure in the bladder. This first successful experience proves uEVT to be a potent interventional alternative in the treatment of bladder defects.

Zusammenfassung

Ziel

Die Methode der aktiven Urinableitung mittels urologischer endoskopischer Vakuumtherapie (uEVT) wird beschrieben. Anhand eines Operationsvideos, welches online zur Verfügung steht, wird zudem die Operationstechnik detailliert dargestellt. Vesikale Fisteln sind eine seltene Komplikation der Rektumchirurgie. Die endoskopische Vakuumtherapie (EVT) ist eine neue interventionelle endoskopische Methode zur Behandlung gastrointestinaler Defekte. Wir zeigen die Adaptierung dieses endoskopischen Verfahrens zur Therapie eines großen Harnblasendefektes mit Urinausfluss aus der perinealen Wunde nach abdominoperinealer Rektumexstirpation.

Material und Methode

Eine neuartige offenporige Foliendrainage (OFD) mit einem Außendurchmesser von wenigen Millimetern wurde aus einer sehr dünnen doppellagigen Drainagefolie und einem Absaugschlauch konstruiert. Die OFD wurde mittels flexibler Endoskopie in die Harnblase eingeführt und suprapubisch ausgeleitet. Mit einer elektronischen Vakuumpumpe wurde ein Unterdruck angelegt und somit auf aktive Weise der Urin kontinuierlich aus der Harnblase abgesaugt. Während der gesamten Behandlungsdauer erfolgte gleichzeitig eine passive Katheterableitung des Urins aus den Nierenbecken über transurethral ausgeführte Mono-J-Schienen. Regelmäßige endoskopische Untersuchungen der Blase dokumentierten den Wundheilungsverlauf.

Ergebnisse

Die Ausübung eines kontinuierlichen Unterdrucks über die OFD führte zum Kollabieren der Harnblase. Der Urin in der Harnblase wurde vollständig aktiv und permanent entlang der OFD drainiert. Der Urinaustritt aus der perinealen Wunde sistierte unmittelbar nach Anlage des Unterdruckes. Nach 18-tägiger Therapiedauer mit uEVT war der Harnblasendefekt verschlossen. Nach Entfernung sämtlicher Katheter hatte der Patient eine normale Miktion.

Fazit

Eine neuartige kleinlumige OFD wurde für die endoskopische Vakuumtherapie entwickelt. Die OFD ermöglicht jetzt auch die urologische Anwendung der endoskopischen Vakuumtherapie. Die uEVT kann eine interventionelle Alternative in der Behandlung von Harnblasendefekten darstellen.

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Acknowledgements

We would like to thank the nursing staff of the interdisciplinary endoscopic unit of Marienkrankenhaus Hamburg for their excellent technical assistance. We thank the Department of Diagnostic and Interventional Radiology of Marienkrankenhaus Hamburg for providing the radiological images.

Funding

The supplement containing this article is not sponsored by industry.

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Authors and Affiliations

  1. Department of General, Abdominal, Thoracic and Vascular Surgery, Katholisches Marienkrankenhaus Hamburg gGmbH, Alfredstraße 9, 22087, Hamburg, Germany

    G. Loske MD,  T. Schorsch MD &  C. T. Müller

  2. Clinic for Urology, Katholisches Marienkrankenhaus Hamburg gGmbH, Hamburg, Germany

    R. U. Kiesow MD

Authors
  1. G. Loske MD
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  2. T. Schorsch MD
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  3. R. U. Kiesow MD
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  4. C. T. Müller
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Corresponding author

Correspondence to G. Loske MD.

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Conflict of interest

G. Loske is a consultant of Lohmann & Rauscher GmbH & Co.KG. T. Schorsch, R. U. Kiesow, and C. T. Müller declare that they have no competing interest.

This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

The German version of this article can be found under doi:10.1007/s00104-016-0297-8

Caption Electronic Supplementary Material

104_2016_318_MOESM1_ESM.mp4

Video: Urinary endoscopic vacuum therapy (uEVT) of a large bladder leakage (© G. Loske, Katholisches Marienkrankenhaus Hamburg gGmbH)

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Loske, G., Schorsch, T., Kiesow, R.U. et al. First report of urinary endoscopic vacuum therapy. Chirurg 88 (Suppl 1), 42–47 (2017). https://doi.org/10.1007/s00104-016-0318-7

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  • DOI: https://doi.org/10.1007/s00104-016-0318-7

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