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


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Department of Urology, Medical University of South Carolina, Charleston, South Carolina. Electronic address: prasads@musc.edu.
Sandip M
SM
Prasad
Section of Urology, University of Chicago Hospitals, Chicago, Illinois.
Michael C
MC
Large
Department of Urology, DuPage Medical Group, Downers Grove, Illinois.
Amit R
AR
Patel
Section of Urology, University of Chicago Hospitals, Chicago, Illinois.
Olufenwa
O
Famakinwa
Section of Urology, University of Chicago Hospitals, Chicago, Illinois.
R Matthew
RM
Galocy
Department of Health Studies, University of Chicago Hospitals, Chicago, Illinois.
Theodore
T
Karrison
Section of Urology, University of Chicago Hospitals, Chicago, Illinois.
Arieh L
AL
Shalhav
Section of Urology, University of Chicago Hospitals, Chicago, Illinois.
Gregory P
GP
Zagaja
D020878:Device Removal; D004322:Drainage / Q000295:instrumentation*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000453:epidemiology / Q000517:prevention & control; D011182:Postoperative Care; D011446:Prospective Studies; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D065287:Robotic Surgical Procedures; D013997:Time Factors; D014546:Urinary Catheterization / Q000295:instrumentation* / Q000379:methods*; D062885:Urinary Catheters
cystostomy; pain; prostatectomy; urethra; urinary catheterization