title: Long-term follow-up of patients undergoing percutaneous suprapubic tube drainage after robot-assisted radical prostatectomy (RARP).
abstract: Study Type - Therapy (case series). Level of Evidence 4 What's known on the subject? and What does the study add? • Initial reports of percutaneous suprapubic tube (PST) drainage following RARP demonstrated feasibility and short-term safety, while decreasing patient discomfort and utilization of anti-cholinergic medication. • This study demonstrates the long-term safety and efficacy of bladder drainage by PST; splinting the urethrovesical anastomosis is simply not essential if mucosal apposition is ensured.
  
  
  OBJECTIVE
  • To evaluate the long-term safety and functional outcomes of patients undergoing percutaneous suprapubic tube (PST) drainage after robot-assisted radical prostatectomy (RARP).
  
  
  METHODS
  • Between January 2008 and October 2009, 339 patients undergoing RARP by one surgeon experienced in RA surgery (M.M.) had postoperative bladder drainage with PST and a minimum of 1-year follow-up for urinary function. • Functional outcomes were obtained via patient-administered questionnaire. • Complications were captured by exhaustive review of multiple datasets, including our prospective prostate cancer database, claims data, as well as electronic medical and institutional morbidity and mortality records.
  
  
  RESULTS
  • Urinary function assessed by patient-administered questionnaire was analysed at a mean (sd) follow-up of 11.5 (1.7) months; after RARP with PST placement, 293 patients (86.4%) had total urinary control and only nine (2.7%) required >1 pad/day. • In all, 86 patients (25.4%) never wore a pad; the median time to 0-1 pad/day was 2 weeks (interquartile range [IQR] 0,6); median time to total control was 6 weeks (IQR 1,22). • The mean (sd) follow-up for complications was 23.7 (6.1) months. In all, 15 patients (4.4%) had a procedure-specific complication, of which 13 were minor (Clavien Class I/II 3.8%); one patient had a bladder neck contracture. • In all, 16 patients (4.7%) required Foley placement after RARP for gross haematuria (two patients), urinary retention (three), tube malfunction (four) or need for prolonged Foley catheterization (seven).
  
  
  CONCLUSIONS
  • PST placement after RARP is safe and efficacious on long-term follow-up. • Splinting of the urethrovesical anastomosis is not a critical step of RP if a watertight anastomosis and excellent mucosal apposition are achieved.
authors.affiliation: Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI 48202, USA. jsammon79@gmail.com
authors.forename: Jesse D
authors.initials: JD
authors.lastname: Sammon
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
authors.forename: Shyam
authors.initials: S
authors.lastname: Sukumar
authors.forename: Mireya
authors.initials: M
authors.lastname: Diaz
authors.forename: Andrea
authors.initials: A
authors.lastname: Simone
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Kaul
authors.forename: Mani
authors.initials: M
authors.lastname: Menon
mesh_terms: D004322:Drainage / Q000295:instrumentation / Q000379:methods*; D004868:Equipment Failure; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000209:etiology; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D012371:Robotics / Q000379:methods*; D014546:Urinary Catheterization / Q000295:instrumentation / Q000379:methods; D014555:Urination Disorders / Q000209:etiology