Early removal of urethral catheter with suprapubic tube drainage versus urethral catheter drainage alone after robot-assisted laparoscopic radical prostatectomy

• Published in: The Journal of urology Vol. 192; no. 1; p. 89
• Main Authors: Prasad, Sandip M, Large, Michael C, Patel, Amit R, Famakinwa, Olufenwa, Galocy, R Matthew, Karrison, Theodore, Shalhav, Arieh L, Zagaja, Gregory P
• Format: Journal Article
• Language: English
• Published: United States 01-07-2014
• Subjects: Device Removal; Drainage - instrumentation; Humans; Laparoscopy; Male; Middle Aged; Pain, Postoperative - epidemiology; Pain, Postoperative - prevention & control; Postoperative Care; Prospective Studies; Prostatectomy - methods; Prostatic Neoplasms - surgery; Robotic Surgical Procedures; Time Factors; Urinary Catheterization - instrumentation; Urinary Catheterization - methods; Urinary Catheters; prostatectomy; pain; cystostomy; urethra; urinary catheterization
• ISSN: 1527-3792
• DOI: 10.1016/j.juro.2014.01.004

Retrospective single institution data suggest that postoperative pain after robot-assisted laparoscopic radical prostatectomy is decreased by early removal of the urethral catheter with suprapubic tube drainage. In a randomized patient population we determined whether suprapubic tube drainage with early urethral catheter removal would improve postoperative pain compared with urethral catheter drainage alone.
Men with a body mass index of less than 40 kg/m(2) who had newly diagnosed prostate cancer and elected robot-assisted laparoscopic radical prostatectomy were included in analysis. Block randomization by surgeon was used and randomization assignment was done after completing the urethrovesical anastomosis. In patients assigned to suprapubic tube drainage the urethral catheter was removed on postoperative day 1 and all catheters were removed on postoperative day 7. Visual analog pain scale and satisfaction questionnaires were administered on postoperative days 0, 1 and 7.
A total of 29 patients were randomized to the urethral catheter vs 29 to the suprapubic tube plus early urethral catheter removal at the time of interim futility analysis. Mean visual analog pain scale scores did not differ between the groups at any time point and a similar percent of patients cited the catheter as the greatest bother with nonsignificant differences in treatment related satisfaction. Complications during postoperative week 1 did not vary between the groups. Based on interim results the trial was terminated due to lack of effect.
Patients randomized to suprapubic tube vs urethral catheter drainage for the week after prostatectomy had similar pain, catheter related bother and treatment related satisfaction in the perioperative period. We no longer routinely offer suprapubic tube drainage with early urethral catheter removal at our institution.