Postoperative patient comfort in suprapubic drainage versus transurethral catheterization following robot-assisted radical prostatectomy: a prospective randomized clinical trial
- 326 Downloads
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.
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.
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.
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.
KeywordsUrinary drainage Urethral catheter Suprapubic tube Radical prostatectomy Discomfort
N. Harke was involved in data analysis and manuscript writing. M. Godes was involved in protocol/project development, data analysis and manuscript writing. J. Habibzada was involved in protocol/project development and data collection and management. C. Wagner was involved in data collection and management. H. Zecha was involved in data analysis. K. Urbanova was involved in protocol/project development, data collection and management and data analysis. M. Addali was involved in protocol/project development and data collection and management. J. H. Witt was involved in protocol/project development, data collection and management data analysis and manuscript writing.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures in this study involving human participants were in accordance with the ethical standards of the institutional committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 10.Tewari A, Rao S, Mandhani A (2008) Catheter-less robotic radical prostatectomy using a custom-made synchronous anastomotic splint and vesical urinary diversion device: report of the initial series and perioperative outcomes. BJU Int 102(8):1000–1004. doi: 10.1111/j.1464-410X.2008.07875.x CrossRefPubMedGoogle Scholar
- 22.Bonkat G, Widmer AF, Rieken M, van der Merwe A, Braissant O, Muller G, Wyler S, Frei R, Gasser TC, Bachmann A (2013) Microbial biofilm formation and catheter-associated bacteriuria in patients with suprapubic catheterisation. World J Urol 31(3):565–571. doi: 10.1007/s00345-012-0930-1 CrossRefPubMedGoogle Scholar
- 24.Prasad SM, Large MC, Patel AR, Famakinwa O, Galocy RM, Karrison T, Shalhav AL, Zagaja GP (2014) Early removal of urethral catheter with suprapubic tube drainage versus urethral catheter drainage alone after robot-assisted laparoscopic radical prostatectomy. J Urol 192(1):89–95. doi: 10.1016/j.juro.2014.01.004 CrossRefPubMedGoogle Scholar