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Superior early and long-term continence following early micturition on day 2 after robot-assisted radical prostatectomy: a randomized prospective trial

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Abstract

Purpose

To elucidate early and long-term continence and patient comfort depending on type and duration of catheterization after robot-assisted radical prostatectomy.

Methods

198 patients were randomized prospectively into three groups (May 2016–July 2017): A transurethral catheter with micturition on postoperative day (POD) 5 was placed in the control group (TD5); a suprapubic tube (SPT) with micturition on POD 5 was placed in the group SD5 or with micturition on POD 2 in group SD2, respectively. Questionnaires were used for catheter-related satisfaction. Functional outcome analysis included residual volume analysis, uroflowmetry, IPSS, 12-h pad test, and daily pad use. Follow-up was conducted up to 12 months.

Results

Postoperative comfort and catheter-related complications were similar in the three groups. However, on the day of catheter removal, continence was significantly better in the 12-h pad test for the SD2 group with 14 ml vs. 30 ml (TD5) and 24 ml (SD5), p = 0.007. Median residual urine volume between the groups was comparable with 17 ml in TD5, 7 ml in SD5, and 11 ml in SD2, (p = 0.07). Postoperative IPSS did not differ significantly in the follow-up period. After 4 weeks, 63% of the patients in SD2 were continent (no pad/day) compared to 33% in TD5 and 41% in SD5, p = 0.004. After 12 months, 76% were continent in TD5, 87% in SD5, and 94% in SD2, p = 0.023.

Conclusions

Early micturition after SPT placement in robotic radical prostatectomy seems to be beneficial without an increased risk of complications.

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Acknowledgments

We would like to thank the study team at PZNW Gronau, especially Gunter Gust and Petra Lange for their help in data acquisition and Dr. Daniela Keller (statistician) for her statistical support.

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Authors and Affiliations

  1. Department of Urology, Pediatric Urology and Urologic Oncology, Prostate Center Northwest, St. Antonius Hospital, Moellenweg 22, 48599, Gronau, Germany

    Nina Natascha Harke, Christian Wagner, Nikolaos Liakos, Katarina Urbanova, Mustapha Addali & Jorn H. Witt

  2. Department of Urology, Essen University Hospital, University of Duisburg-Essen, Essen, Germany

    Boris A. Hadaschik

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  1. Nina Natascha Harke
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Contributions

NH protocol/project development, data collection and management, data analysis, and manuscript writing. CW data collection and management, and manuscript editing. NL data collection and management. KU data collection and management, and manuscript editing. MA data collection and management. BH manuscript editing. JHW protocol/project development, data collection and management, and manuscript editing.

Corresponding author

Correspondence to Nina Natascha Harke.

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Conflict of interest

Nina N. Harke: personal fees and non-financial support from Bayer, personal fees and non-financial support from Novartis, personal fees and non-financial support from Lightpoint Medical, personal fees and non-financial support from Boston Scientific; all outside the submitted work. Christian Wagner: Proctor for Intuitive Surgical. Boris Hadaschik: German Cancer Aid, grants from German Research Foundation, grants from Profound Medical, grants, personal fees and non-financial support from Janssen, personal fees and non-financial support from Astellas, personal fees and non-financial support from Bayer, personal fees and non-financial support from BMS, personal fees and non-financial support from Lightpoint Medical, personal fees and non-financial support from Astra Zeneca, personal fees and non-financial support from Sanofi, grants and personal fees from Uromed; all outside the submitted work. Jorn H. Witt: Proctor for Intuitive Surgical, personal fees and non-financial support from BK Ultrasound, personal fees and non-financial support from Braun, personal fees and non-financial support from Applied, personal fees and non-financial support from Ethicon, personal fees and non-financial support from Lohmann&Rauscher, personal fees and non-financial support from Olympus, personal fees and non-financial support from TapMed, personal fees and non-financial support from Teleflex, personal fees and non-financial support from Mimic, personal fees and non-financial support from IFM, personal fees and non-financial support from Orpheus Medical, personal fees and non-financial support from Stryker, personal fees and non-financial support from Uromed, personal fees and non-financial support from Boston Scientific, personal fees and non-financial support from Bard; all outside the submitted work. Nikolaos Liakos, Katarina Urbanova, and Mustapha Addali do not have any conflicts of interests.

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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.

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Informed consent was obtained from all individual participants included in the study.

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Harke, N.N., Wagner, C., Liakos, N. et al. Superior early and long-term continence following early micturition on day 2 after robot-assisted radical prostatectomy: a randomized prospective trial. World J Urol 39, 771–777 (2021). https://doi.org/10.1007/s00345-020-03225-9

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  • DOI: https://doi.org/10.1007/s00345-020-03225-9

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