Urinary Outcomes after Magnetic Resonance Imaging-Guided Whole Gland Transurethral Ultrasound Ablation (TULSA) for Prostate Cancer: Comparison of Suprapubic Tube to Indwelling Urethral Catheter.

Magnetic resonance imaging-guided transurethral ultrasound ablation (TULSA) is under investigation for whole gland ablation of low and intermediate risk prostate cancer. The ideal method for post-TULSA bladder drainage via postoperative suprapubic tube (SPT) versus indwelling urethral catheter (UC) has not been established.

The objective of this study was to evaluate urinary outcomes after whole gland TULSA, comparing postoperative SPT to UC.

Two-institution, retrospective analysis of whole gland TULSA for men with grade group 1 and 2 prostate cancer. One institution placed SPT at the time of TULSA with clamp trials (day 10) and removal once voiding. The second placed UC until void trial (day 7). Outcomes included the International Prostate Symptom Score (IPSS), urinary bother score, catheter reinsertion, stricture, clean intermittent catheterization (CIC), and incontinence.

Forty-five patients (median age 67) were analyzed. The UC cohort (N=26) was older (P=0.007) than the SPT cohort (N=19) but with similar baseline prostate volumes, IPSS and urinary bother scores. Patients receiving UC had fewer days with catheter (P=0.013). Although UC patients suffered more lower urinary tract symptoms at one-month post-TULSA, there was no significant difference between IPSS scores at six months after surgery and at baseline regardless of urinary management strategy, though the UC group noted significantly decreased urinary bother. Rates of infection were similar between groups. Six strictures were observed overall with more in the SPT group, though the difference was not significant (4/19 [21.1%] SPT; 2/26 [7.7%] UC). At 6 months, incontinence rates were low and similar between groups (2/19 [10.5%] SPT; 4/26 [15.4%] UC) and only one patient (UC) required CIC.

Our overall findings suggest that SPT and UC are both acceptable options for postoperative bladder drainage following whole gland TULSA, with statistically similar rates of urinary complications but a slightly different side effect profile.

Journal of endourology. 2022 Aug 26 [Epub ahead of print]

Matthew J Rabinowitz, Nora M Haney, Amanda A Myers, Chandler Dora, Christian Pavlovich

Johns Hopkins University School of Medicine, The James Buchanan Brady Urological Institute, Department of Urology, Baltimore, Maryland, United States; ., Johns Hopkins University School of Medicine, The James Buchanan Brady Urological Institute, Department of Urology, Baltimore, Maryland, United States; ., Mayo Clinic in Florida, Department of Urology, Jacksonville, Florida, United States; ., Mayo Clinic in Florida, Department of Urology, Jacksonville, Florida, United States; ., Johns Hopkins University School of Medicine, The James Buchanan Brady Urological Institute, Department of Urology, Baltimore, Maryland, United States; .

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