Transurethral Retrograde Approach to Pelvic Abscess Drainage in Post-cystectomy Patients

One potential complication of radical cystectomy is the development of a pelvic abscess requiring drainage. Transurethral drainage has been described for the treatment of prostatic abscesses but is particularly well tolerated in patients for whom pelvic fluid drainage is needed following radical cystectomy. Although percutaneous, transrectal, or transvaginal approaches to pelvic drain placement are possible, the transurethral route provides a fully epithelialized tract through which the drainage catheter can traverse and which does not require unnecessary tissue puncture. Although blind Foley catheter placement could potentially be used for transurethral drainage in these patients, urologic surgeons have preferred fluoroscopically guided drain placement to ensure atraumatic placement and optimal drain positioning. In a stepwise fashion, this chapter describes how to perform fluoroscopy-guided transurethral abscess drainage in patients following cystectomy.