Robot-Assisted Partial Nephrectomy: Is routine urinary catheterization still mandatory in the era of enhanced recovery?

To assess the benefits and safety of non-catheterization during robot-assisted partial nephrectomy within an enhanced recovery protocol.

A single-center retrospective comparative study was carried out of consecutive patients who underwent a robot-assisted partial nephrectomy between February 2015 and December 2017 within an early recovery program. The patients who received a urinary catheter were compared with those who did not in terms of postoperative complications, acute urinary retention rates, urinary tract infection rates, and lengths of hospital stay.

Of the 145 patients who followed an early recovery program after robot-assisted partial nephrectomy in the study period, 96 received a urinary catheter and 49 did not. There was no significant difference between these two groups in terms of the rates of acute urinary retention (3% vs 6%, respectively; p = 0.393), urinary tract infection (3% vs 2%; p = 0.707), postoperative complications (14% vs 18%; p = 0.445), or readmissions within 30 days (8% vs 6%; p = 0.636). However, patients who did not receive a catheter had shorter initial and total (including readmissions) lengths of hospital stay (respectively 2.16 vs 2.56 days; p = 0.058, and 2.27 vs 3.40 days; p < 0.001).

Our findings challenge the routine use of urinary catheterization during robot-assisted partial nephrectomies. Non-catheterization does not seem to increase the risk of postoperative urinary retention. Only catheterizing specific at-risk patients may prove beneficial.

Urology. 2018 Oct 06 [Epub ahead of print]

Benjamin Tremblais, Inès Dominique, Jean-Etienne Terrier, René Ecochard, Hélène Hacquard, Alain Ruffion, Philippe Paparel

Department of Urology. Lyon Sud-Pierre Bénite Teaching Hospital, 69310 France. Electronic address: ., Department of Urology. Lyon Sud-Pierre Bénite Teaching Hospital, 69310 France. Electronic address: ., Department of Urology. Lyon Sud-Pierre Bénite Teaching Hospital, 69310 France. Electronic address: ., Department of Statistics. Hospices Civils de Lyon, Biostatistics, F-69003, Lyon, France; University of Lyon, F-69000, Lyon, France; University Lyon 1, F-69100, Villeurbanne, France; CNRS, UMR5558, Laboratory of Biometry and Evolutionary Biology, Biostatistics Team-Health, F-69100, Villeurbanne France. Electronic address: ., Department of Urology. Lyon Sud-Pierre Bénite Teaching Hospital, 69310 France. Electronic address: ., Department of Urology. Lyon Sud-Pierre Bénite Teaching Hospital, 69310 France. Electronic address: ., Department of Urology. Lyon Sud-Pierre Bénite Teaching Hospital, 69310 France. Electronic address: .