title: Postoperative patient comfort in suprapubic drainage versus transurethral catheterization following robot-assisted radical prostatectomy: a prospective randomized clinical trial.
abstract: OBJECTIVE
  To evaluate the impact of the type of urinary diversion (suprapubic vs. transurethral catheterization) on patients' postoperative pain after radical prostatectomy, development of bacteriuria and long-term functional results.
  
  
  METHODS
  A randomized, prospective clinical trial was performed including 160 patients who underwent robot-assisted radical prostatectomy after randomization into two groups: intraoperatively, a transurethral catheter (control group) or an additional suprapubic tube (with removal of the transurethral catheter in the morning of postoperative day 1; intervention group) was placed. Primary study endpoint was postoperative pain objectified by the numeric rating scale questionnaire. Secondary endpoints were bacteriuria after catheter removal and functional outcomes after up to 2 years of follow-up.
  
  
  RESULTS
  There were no significant differences in demographic and perioperative data. Starting on postoperative day 2, patients in the suprapubic diversion group had significantly less pain on every time point preceding the removal of the catheter compared to the control cohort with a median overall numeric rating score on postoperative day 1-4 of 2.4 points in the transurethral versus 1.3 in the intervention group (p = 0.012). No statistical difference was found in postoperative bacteriuria and complications as well as in functional results, quality of life and incontinence rates after a median follow-up of 22 months.
  
  
  CONCLUSIONS
  Suprapubic drainage in robot-assisted radical prostatectomy shows significantly decreased pain levels during the catheterization period compared to the transurethral diversion without compromising long-term functional results. Intraoperative placement of a suprapubic tube should be discussed as a standard procedure for further improvement of patients' postoperative comfort.
authors.affiliation: Department of Urology, Pediatric Urology and Urologic Oncology - Prostate Center Northwest, St. Antonius Hospital, Moellenweg 22, 48599, Gronau, Germany. harkenina@gmail.com.
authors.forename: Nina
authors.initials: N
authors.lastname: Harke
authors.affiliation: Department of Urology, Pediatric Urology and Urologic Oncology - Prostate Center Northwest, St. Antonius Hospital, Moellenweg 22, 48599, Gronau, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Godes
authors.affiliation: Department of Urology, Pediatric Urology and Urologic Oncology - Prostate Center Northwest, St. Antonius Hospital, Moellenweg 22, 48599, Gronau, Germany.
authors.forename: Jawid
authors.initials: J
authors.lastname: Habibzada
authors.affiliation: Department of Urology, Pediatric Urology and Urologic Oncology - Prostate Center Northwest, St. Antonius Hospital, Moellenweg 22, 48599, Gronau, Germany.
authors.forename: Katarina
authors.initials: K
authors.lastname: Urbanova
authors.affiliation: Department of Urology, Pediatric Urology and Urologic Oncology - Prostate Center Northwest, St. Antonius Hospital, Moellenweg 22, 48599, Gronau, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Wagner
authors.affiliation: Department of Urology, Pediatric Urology and Urologic Oncology - Prostate Center Northwest, St. Antonius Hospital, Moellenweg 22, 48599, Gronau, Germany.
authors.forename: Henrik
authors.initials: H
authors.lastname: Zecha
authors.affiliation: Department of Urology, Pediatric Urology and Urologic Oncology - Prostate Center Northwest, St. Antonius Hospital, Moellenweg 22, 48599, Gronau, Germany.
authors.forename: Mustapha
authors.initials: M
authors.lastname: Addali
authors.affiliation: Department of Urology, Pediatric Urology and Urologic Oncology - Prostate Center Northwest, St. Antonius Hospital, Moellenweg 22, 48599, Gronau, Germany.
authors.forename: Jorn H
authors.initials: JH
authors.lastname: Witt
mesh_terms: D000368:Aged; D001437:Bacteriuria / Q000453:epidemiology*; D003559:Cystostomy / Q000379:methods*; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D010149:Postoperative Pain / Q000453:epidemiology*; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D065287:Robotic Surgical Procedures; D014546:Urinary Catheterization / Q000379:methods*
keywords: Discomfort; Radical prostatectomy; Suprapubic tube; Urethral catheter; Urinary drainage