Neobladder anastomotic leaks are seen in 2-10 % of cases. Most of these cases can be managed conservatively. However, in non-responding cases, some form intervention is needed. Here, we demonstrate successful management of a neobladder anastomotic leak using N-butyl cyanoacrylate (NBCA) glue using percutaneous embolization approach only.

A 53-years-old patient diagnosed with muscle-invasive bladder cancer (MIBC) underwent robot-assisted radical cystectomy (RARC) with orthotopic neobladder (ONB) and pelvic lymph node dissection (PLND) with us. Post-operative recovery was uneventful. However, on cystogram at 3 weeks, he had anastomotic leak of significant size. He was kept on per-urethral and suprapubic catheters and repeat cystogram after another 2 weeks failed to show any sign of improvement. He was taken to the interventional radiology suite, where the leak cavity was treated with an NBCA-lipoidal mixture. This was performed after a gentle tug on the per-urethral catheter to facilitate the adhesion of the leak edges and to prevent the NBCA from leaking into the urinary tract. Immediate cystogram demonstrated successful procedure and no leak. Per urethral catheter was kept for another 1 week.

Cystogram done 1-week after the administration of NBCA showed no leak with glue opacifying the entire leak cavity. Catheter was then removed and patient voided successfully. CT Urogram with 3D-reconstruction done after 3 months showed no extravasation of contrast from neobladder.

Neobladder anastomotic leaks are uncommon and difficult to manage. Failure to manage conservatively usually mandates surgical repair. However, an early intervention with percutaneous occlusion approach using our novel technique can achieve successful closure of the fistula, offering a minimal-invasive alternative to surgery with good patient satisfaction.