title: Early catheter removal after radical retropubic prostatectomy: long-term followup.
abstract: OBJECTIVE
  We examine the complication and continence rates with early catheter removal (day 3 or 4) after radical retropubic prostatectomy.
  
  
  METHODS
  A total of 365 patients with localized prostate cancer underwent radical retropubic prostatectomy at Indiana University Hospital with planned urethral catheter removal before discharge home. Low pressure cystograms were performed on postoperative day 3 or 4 to determine if catheter removal was possible. A subset of patients were analyzed using a validated prostate cancer specific questionnaire (University of California, Los Angeles Prostate Cancer Symptom Index) to determine quality of life outcomes.
  
  
  RESULTS
  The catheter was removed on postoperative day 3 or 4 in 263 patients (72%). The reasons for leaving the catheter indwelling were significant leak on cystogram or excessive suprapubic drainage (21%), extensive bladder neck reconstruction (1%) and prolonged hospitalization because of an ileus or other complicating factor (6%). Thirteen patients (3.6%) were either unable to void after catheter removal or presented with retention (not associated with hematuria or clots) after hospital discharge, requiring reinsertion of the Foley catheter. A total of 41 patients (11%) had either an early or late complication (excluding incontinence). There were 3 complications (0.8%) that were considered major because they were potentially life threatening or required a return to the operating room. A pelvic abscess developed in 2 patients and a lymphocele in 1, which required percutaneous drainage. After at least 6 months (mean 20.9 months) 140 patients (89.2%) and 14 (8.9%) reported excellent and good continence, respectively. The patient questionnaire demonstrated bother scores to be minimal to no bother for 95% to 98% of patients at 6 and 12 months.
  
  
  CONCLUSIONS
  This study confirms that it is safe to remove catheters in most patients 3 to 4 days after prostatectomy if a cystogram demonstrates no extravasation. Complication rates and continence rates with this approach compare favorably with series in which catheters are left indwelling for longer periods.
authors.affiliation: Department of Urology, Indiana University Medical School, Indianapolis, Indiana, USA.
authors.forename: Michael O
authors.initials: MO
authors.lastname: Koch
authors.forename: Anish H
authors.initials: AH
authors.lastname: Nayee
authors.forename: James
authors.initials: J
authors.lastname: Sloan
authors.forename: Thomas
authors.initials: T
authors.lastname: Gardner
authors.forename: Greg R
authors.initials: GR
authors.lastname: Wahle
authors.forename: Richard
authors.initials: R
authors.lastname: Bihrle
authors.forename: Richard S
authors.initials: RS
authors.lastname: Foster
mesh_terms: D020878:Device Removal / Q000009:adverse effects; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011182:Postoperative Care; D011183:Postoperative Complications; D011468:Prostatectomy / Q000009:adverse effects; D012189:Retrospective Studies; D014546:Urinary Catheterization / Q000009:adverse effects; D014549:Urinary Incontinence / Q000209:etiology; D016055:Urinary Retention / Q000209:etiology