Safety and outcome of early catheter removal after radical retropubic prostatectomy

Abstract

Objectives To assess the outcomes of patients who underwent radical retropubic prostatectomy (RRP) and had their indwelling urinary catheter removed on postoperative day 4 or later. Methods The medical records of 342 consecutive patients undergoing RRP by a single surgeon were retrospectively reviewed. None of these patients had received radiotherapy, transurethral resection, or simple prostatectomy before RRP. The 342 patients were categorized into two groups according to the length of catheterization. Group 1 (n = 127) had the urethral catheter removed on postoperative day 4, and group 2 (n = 215) had the catheter removed later than postoperative day 4. Removal of the urinary catheter was only done if control cystography failed to demonstrate anastomotic extravasation. In the case of acute urinary retention, home care nurses and emergency room personnel reinserted the urinary catheter without cystoscopic assistance. Incontinence was rated according to the number of protective pads used in a 24-hour period as follow: none, mild (1 pad/day), moderate (more than 1 but 3 or fewer pads/day), and severe (more than 3 pads/day). Results The mean age of the study population was 61.5 ± 6.1 years. Acute urinary retention after catheter removal occurred in 11 patients (3%), 4 from group 1 and 7 from group 2. None of the patients requiring catheter reinsertion presented with complications related to this event. The overall continence rate was 58%, 85%, and 92% at 3, 9, and 12 months, respectively. The continence rates at 3, 9, and 12 months were higher for group 1 than for group 2 ( P = 0.0002, P = 0.011, and P = 0.044, respectively). Bladder neck contracture was encountered in 14 patients (4%), 2 (2%) from group 1 and 12 (6%) from group 2. The only factor predicting continence was the duration of bladder catheterization. Conclusions Bladder catheters can be safely removed on postoperative day 4 in patients with normal cystograms after RRP. The continence and anastomotic stricture rates were improved in patients with 4 days of indwelling catheterization.