title: Early Catheter Removal after Robot-assisted Radical Prostatectomy: Surgical Technique and Outcomes for the Aalst Technique (ECaRemA Study).
abstract: Robot-assisted radical prostatectomy (RARP) is a widespread option for the treatment of patients with clinically localised prostate cancer. Modifications in the surgical technique may help to further improve functional outcomes.
  
  
  
  To assess the outcome of early catheter removal 48h after surgery, as opposed to standard catheter removal 6 d after surgery following RARP, using a newly developed surgical technique for posterior reconstruction and anastomosis (Aalst technique).
  
  
  
  Patients scheduled for RARP were prospectively scheduled for early catheter removal at postoperative d 2 (group A, n=37) and standard catheter removal at postoperative d 6 (group B, n=37).
  
  
  
  RARP was performed using the Da Vinci Si system. The Aalst technique for the urethro-vesical anastomosis including posterior reconstruction was used as previously described.
  
  
  
  The primary endpoint was spontaneous voiding after catheter removal. Secondary endpoints were rate of anastomotic urinary leakage after catheter removal, presence and severity of urethral, perineal, and abdominal pain, as well as patient's bother after catheter removal using visual analogue scale (VAS) scores. Rate and severity of urinary incontinence after catheter removal were assessed using the International Consultation on Incontinence Questionnaire-Male Lower Urinary Tract Symptoms Module (ICIQ-MLUTS) questionnaire.
  
  
  
  There was no significant difference between the groups with regard to baseline and perioperative parameters, as well as pathological features; however, significantly more patients underwent bilateral nerve-sparing procedures in group A (34 vs 23, p=0.008). After catheter removal, patients in both groups showed spontaneous voiding, whereas only 11% and 8% of the patients in group A and group B experienced urinary retention after catheter removal (p=0.7). Patients in group B had significantly higher maximum flow rates, but lower voided volumes after catheter removal in comparison with patients in group A (21ml/s vs 10ml/s, p≤0.001 and 170ml vs 200ml, p≤0.001, respectively). ICIQ-MLUTS questionnaire and VAS scores showed no significant differences between the groups at any time point.
  
  
  
  The Aalst technique allows the removal of catheters 2 d after RARP and results in spontaneous voiding. Early removal showed no increased rate of urinary leakage, no negative impact on short-term continence and on perineal, urethral or penile pain, and no increase in urinary retention rates. Future studies have to confirm these results with longer follow-up including detailed parameters on return to daily activity.
  
  
  
  We provide evidence that it is possible to remove the bladder catheter as early as 2 d after robot-assisted radical prostatectomy without any negative effects on voiding and pain parameters. Thus, leaving the hospital early without a catheter in place could represent a significant and relevant benefit for the patient.
authors.affiliation: Department of Urology, LMU Munich, Germany; OLV Vattikuti Robotic Surgery Institute, Melle, Belgium. Electronic address: christian.gratzke@med.uni-muenchen.de.
authors.forename: Christian
authors.initials: C
authors.lastname: Gratzke
authors.affiliation: OLV Vattikuti Robotic Surgery Institute, Melle, Belgium.
authors.forename: Zach
authors.initials: Z
authors.lastname: Dovey
authors.affiliation: OLV Vattikuti Robotic Surgery Institute, Melle, Belgium; Department of Surgery, Oncology, and Gastroenterology, Urology Clinic University of Padua, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Novara
authors.affiliation: Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Geurts
authors.affiliation: Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium.
authors.forename: Ruben
authors.initials: R
authors.lastname: De Groote
authors.affiliation: Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium.
authors.forename: Peter
authors.initials: P
authors.lastname: Schatteman
authors.affiliation: Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium.
authors.forename: Geert
authors.initials: G
authors.lastname: de Naeyer
authors.affiliation: Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium; OLV Vattikuti Robotic Surgery Institute, Melle, Belgium; Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Gandaglia
authors.affiliation: Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium; OLV Vattikuti Robotic Surgery Institute, Melle, Belgium.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mottrie
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D057868:Anastomotic Leak / Q000209:etiology; D020878:Device Removal / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology; D011182:Postoperative Care; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D065287:Robotic Surgical Procedures / Q000009:adverse effects; D011795:Surveys and Questionnaires; D013997:Time Factors; D014521:Urethra / Q000601:surgery*; D001743:Urinary Bladder / Q000601:surgery*; D062885:Urinary Catheters; D014549:Urinary Incontinence / Q000209:etiology; D016055:Urinary Retention / Q000209:etiology; D014554:Urination; D014563:Urodynamics
keywords: Anastomosis; Continence; Posterior reconstruction; Prostate cancer; Robot-assisted radical prostatectomy