NARUS 2018: Suprapubic catheter use following Retzius-Sparing Robotic Radical Prostatectomy

Las Vegas, NV (UroToday.com) Dr. Kusuma and colleagues from the UK presented results of their use of a suprapubic catheter following retzius-sparing robotic radical prostatectomy. Over the past several years there has been reports from centers of excellence touting the improved urinary continence [1,2], as well as a single institution pragmatic randomized controlled trial reporting improved urinary continence and decreased urinary bother with the retzius-sparing approach [3]. The objective of the current study was to assess the consequences of using a suprapubic catheter instead of urethral catheter following retzius-sparing robotic prostatectomy.

Between May 2016 and September 2017, 164 patients underwent retzius-sparing robotic prostatectomy. The initial 39 patients had a urethral catheter and the following 125 patients had a suprapubic catheter. Among these 125 patients, the urethral catheter was removed immediately following suprapubic catheter insertion. Complications were both physician and patient reported and were recorded prospectively. 

The median duration of catheterization for patients with a suprapubic catheter was 9 (IQR 9-9) and 14 days for patients with urethral catheters (IQR 14-14). The overall complication rate was 5.5% for patients with a suprapubic catheter and 20.5% for patients with a urethral catheter (p=0.01), of which all were Clavien grade 1-2. Patients with a urethral catheter had 25-fold increased risk of infected urine at the time of the voiding trial (p=0.0004). There were no instances of urethra or bladder neck contracture noted in either group at a mean follow-up of 8 months (range 1-16).

The authors concluded that retzius-sparing robotic prostatectomy has renewed interest in suprapubic catheter use after radical prostatectomy as it is more comfortable for the patients than a urethral catheter. Furthermore, the lack of bladder neck or urethral stricture following suprapubic catheter use questions the traditional dogma that a vesicourethral anastomosis needs to be stented following radical prostatectomy to prevent cross-adhesions. 


Presented By: Venkata R.M. Kusuma, Dapartment of Urology, Royal Surrey County Hospital, Guildford, UK

Co-Authors: Pavlos Pavlakis, Dimitrios Moschanos, Christopher Eden

Written By: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre, @zklaassen_md ,at the 2018 North American Robotic Urology Symposium, February 16-17, 2018 - Las Vegas, NV 

References: 

1. Sayyid RK, Simpson WG, Lu C, et al. Retzius-sparing robotic-assisted laparoscopic radical prostatectomy: A safe surgical technique with superior continence outcomes. J Endourol 2017;31(12):1244-1250.
2. Menon M, Dalela D, Jamil M, et al. Functional recovery, oncologic outcomes and postoperative complications 12 months following robotic-assisted radical prostatectomy: Followup of an evidence-based analysis comparing the Retzius sparing and standard approaches. J Urol Dec 7 [Epub ahead of print].
3. Dalela D, Jeong W, Prasad MA, et al. A pragmatic randomized controlled trial examining the impact of the Retzius-sparing approach on early urinary continence recovery after robot-assisted radical prostatectomy. Eur Urol 2017;72(5):677-685.