Radical cystoprostatectomy (RCP) with pelvic lymph node dissection, urethrectomy and ileal conduit formation is a complex surgical procedure with significant morbidity. We highlight the novel use of an infrapubic urinary catheter balloon tamponade for the management of persistent retropubic bleeding during this procedure

A male in his 70s underwent radical cystoprostatectomy (RCP), pelvic node dissection, urethrectomy, and ileal conduit creation for high-grade T1 urothelial carcinoma involving the bladder and prostate. During the procedure, moderate bleeding from the dorsal venous complex (DVC) and vascular pedicles required initial suture ligation and pelvic packing. However, persistent bleeding, despite repeat suture ligation and inspection via a perineal incision, necessitated an additional infrapubic incision to achieve haemostasis

The infrapubic incision provided easier access to the DVC. The retropubic site was packed with a haemostatic matrix, with digital pressure applied. A 24Fr 2-way Foley catheter was inserted into the retropubic space through the infrapubic incision, with 60ml of water in the balloon for manual pressure (Figure 1) and was placed on traction to tamponade the bleeding (Figure 2). Haemostasis was achieved, enabling procedure completion and closure. Postoperative CT confirmed catheter placement (Figure 3).

Infrapubic Foley catheter balloon tamponade is a viable option to achieve haemostasis during radical cystoprostatectomy and urethrectomy