Abstract
ObjectiveTo compare prospectively early outcome and complications of catheter removal after robot-assisted radical prostatectomy (RARP) on the 4th or 7th day with a standardized running barbed suture technique.IntroductionThe time point of removing the indwelling catheter after RARP mainly depends on institute’s/surgeon’s preferences. Removal should be late enough to avoid urinary leakage and complications such as acute urinary retention (AUR) but early enough to avoid unnecessary catheter indwelling.Materials and methodsA consecutive single-institutional series of patients underwent RARP between July 2015 and August 2017 and were entered in a prospectively maintained data base. Between July 2015 and December 2016 a cystogram was performed on 7th postoperative day (group A), thereafter the cystogram was performed on 4th postoperative day (group B). Incidence of acute urinary retention (AUR), urinary tract infections (UTI) and adverse events between the two cohorts was compared.Results425 patients were analyzed (group A: n = 231; group B: n = 194). Both cohorts were comparable regarding demographic and oncological parameters. Watertight anastomosis was present in 84.8% in group A and in 82.5% in group B, respectively. AUR within 4 weeks after RARP occurred in 2.2% (n = 3) in A and 9.4% (n = 15) in B (p = 0.001). AUR within 72 h after catheter removal occurred in group A: 1% (n = 2) and in group B: 6.3% (n = 10) (p = 0.005). Symptomatic urinary tract infections occurred in 8.2% (n = 16) in group A and in 6.9% (n = 11) in group B. There were no differences in the rate of secondary anastomosis dehiscence. Age, BMI, prostate size, surgeon, or intraoperative bladder neck reconstruction were not correlated to the occurrence of AUR or UTI.ConclusionsThe removal of indwelling catheter on day 4 after a RARP with a running barbed suture shows similar anastomosis leakage rates as on the 7th postoperative day. However, AUR rates are higher for early removal. Patients scheduled for early removal should be carefully informed about the increased risk for AUR. Catheter indwelling time does not represent a risk factor for UTI.
Highlights
The ideal time of catheter removal after robot-assisted radical prostatectomy (RARP) is still controversially discussed
A few studies analyzed the issue of timing of catheter removal in more detail with heterogeneous study designs, all showing that early removal is feasible, yet prone to a higher complication rate
Catheter removal may result in a higher rate of re-catheterization due to acute urinary retention (AUR), secondary urinary leakage or anastomotic disruption [1, 2]
Summary
The ideal time of catheter removal after robot-assisted radical prostatectomy (RARP) is still controversially discussed. Timing of catheter removal shows a wide range, according to institute’s/surgeon’s preferences. A few studies analyzed the issue of timing of catheter removal in more detail with heterogeneous study designs, all showing that early removal is feasible, yet prone to a higher complication rate. Catheter removal may result in a higher rate of re-catheterization due to acute urinary retention (AUR), secondary urinary leakage or anastomotic disruption [1, 2]. A prolonged catheterization time, leads to patient discomfort and implicates the risk of catheter dependent complications, such as urinary tract infections, and negatively impacts on short- and intermediate urinary continence rates [3,4,5,6]. Determining the ideal timing for catheter removal enhances patient’s care in the postoperative setting
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
