Risk and Prevention of Acute Urinary Retention After Robotic Prostatectomy

Abstract

Acute urinary retention after catheter removal is a recognized complication following open or robot-assisted radical prostatectomy. We evaluated patient and surgery related risk factors to determine whether acute urinary retention could be prevented. To our knowledge this has not previously been investigated for prostatectomy done by any technique. We reviewed a single surgeon, robot-assisted radical prostatectomy database of patients treated between February 2008 and June 2011 for acute urinary retention after catheter removal, which was routinely performed 3 to 7 days postoperatively. We compared the characteristics of patients with and without acute urinary retention. Of 1,026 patients 25 (2.4%) experienced acute urinary retention. There was no difference between patients with and without acute urinary retention in mean age, body mass index, blood loss or prostate size, and no difference in the frequency of bladder neck reconstruction or nerve sparing. The catheter was removed an average of 4.1 vs 5.7 days postoperatively in patients with vs without acute urinary retention. Of 25 patients with acute urinary retention 22 (88%) underwent catheter removal on postoperative day 3 or 4. Although only 3 of 381 patients (0.8%) had a leak on cystogram on postoperative day 3 or 4, the acute urinary retention rate when the catheter was removed on day 3 or 4 was 5.8% (22 of 381). This was several times higher than the rate in patients who retained the catheter for greater than 4 days (3 of 645 or 0.5%). Acute urinary retention develops infrequently after robotic prostatectomy. No patient related risk factors were identified beyond catheterization time. Although the catheter may be removed after 3 or 4 days with rare leaks, the acute urinary retention risk was much less when the catheter was left in place at least 5 days.