RALP Without Catheters May Be Possible

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Percutaneous suprapubic tube (PST) for bladder drainage after robotic-assisted laparoscopic radical prostatectomy (RALP) is associated with less patient discomfort than urethral catheters, a study found.

Researchers at Henry Ford Health Systems in Detroit studied 202 RALP patients who had a PST inserted instead of a urethral catheter. The PST was placed robotically at the conclusion of the urethrovesical anastomosis and secured to the skin over a plastic button.

The investigators, led by Mahendra Bhandari, MD, compared these patients with a control group of 50 control patients undergoing RALP with urethral catheter drainage. The primary end point was catheter-associated discomfort as measured with the Faces Pain Score-Revised (FPS-R) version of the Visual Analog Scale.

Compared with the urethral catheter group, the PST patients had significantly decreased catheter-related discomfort on postoperative days 2 and 6, researchers reported in European Urology (2009;56:325-331). For example, in the PST group, 17.8% and 61.9% of patients reported FPS-R scores of 0 and 1-2 at postoperative day 2, compared with 2% and 26% of controls. A significantly smaller proportion of PST patients reported scores of 3-4 (12.9% vs. 38%) and 5-6 (5.4% vs. 18%).

At postoperative day 6, 59.4% of PST patients reported a score of 0 compared with 24% of controls. Nearly 34% of PST patients reported a score of 1-2 compared with 44% of controls, but the difference between the groups was not significant. However, a significantly smaller proportion of PST patients reported scores of 3-4 (5.4% vs. 24%) and 5-6 (1.5% vs. 8%).

Ten patients required urethral catheterization for PST dislodgment or urinary retention. Urethral stricture did not develop in any patient after a mean follow-up period of seven months.

On postoperative day 6, the median post-void residual volume measured via the suprapubic tube was 25 mL. The mean duration of PST drainage was 7.6 days.

Return to continence was similar in the two groups. When the researchers defined post-RALP urinary continence as the use of 0-1 pads per 24 hours, 50% of PST patients and 46% of controls were continent within 48 hours of tube or catheter removal. At 90 days, continence increased to 90% of PST patients and 92% of controls.

When incontinence was defined more strictly as no pad usage, 44% of PST patients and 14% of controls were continent within 48 hours of catheter removal. At 90 days, the overall continence rates were 67% for the PST patients and 64% for controls.

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