Evaluation of the functional results and safety of early removal of the urethral catheter after laparoscopic radical prostatectomy

Background. Currently, there is no single point of view on the timing of safe removal of the urethral catheter in patients who have undergone laparoscopic radical prostatectomy.

Objective of the study: to evaluate the safety and functional results of early removal of the urethral catheter after laparoscopic radical prostatectomy.

Materials and methods. In the period from January 2020 until April 2021, the study included 100 patients with a diagnosis of prostate cancer who underwent laparoscopic radical prostatectomy by one surgeon. Patients were divided into 2 groups. Group A (n = 50) included patients with the urethral catheter removed on the second day after surgery. Group B (n = 50) – the control group – included patients with standard catheter removal (14 days).

Results. According to the results of cystography, in group A extravasation of a contrast agent from the zone of urethrovesical anastomosis was determined in 3 (6 %) cases. Seven (14 %) patients developed acute urinary retention after the removal of the urethral catheter. Among 2 patients acute urinary retention occurred immediately after catheter removal. In 5 cases acute urinary retention developed 2–7 days after catheter removal. These patients underwent repeated catheterization for a period of 2–3 days. In our study, removal of the urethral catheter on the second day increased the dynamic of restoring urinary continence in the postoperative period. The frequency of complete recovery of urinary continence (0–1 pad per day) in the groups A and B, respectively, was: after 1 month – 22 and 16 %, after 6 months – 64 and 54 %, after 12 months – 78 and 78 %. Urinary incontinence in the groups A and B was as follows: mild (2–3 pads per day): after 1 month – 40 and 34 %, after 6 months – 30 and 32 %, after 12 months – 20 and 18 %; moderate (4–5 pads per day): after 1 month – 20 and 26 %, after 6 months – 6 and 10 %, after 12 months – 2 and 2 %; severe (6 pads or more): after 1 month – 18 and 24 %, after 6 months – 0 and 4 %, after 12 months – 0 and 2 %.

Conclusion. Early removal of the urethral catheter (2 days) in patients who underwent laparoscopic radical prostatectomy is a relatively safe method that improves the restoration of urinary continence.

1. State of oncological care in Russia in 2020. Eds.: А.D. Kaprin, V.V. Starinskiy, A.О. Shachzadova. Moscow: MNIOI im. P.A. Gertsena – filial FGBU “NMITS radiologii” Minzdrava Rossii, 2021. 239 p. (In Russ.).

2. Lista G., Lughezzani G., Buffi N.M. et al. Early catheter removal after robot-assisted radical prostatectomy: results from a prospective single-institutional randomized trial (Ripreca Study). Eur Urol Focus 2020;6(2):259–66. DOI: 10.1016/j.euf.2018.10.013.

3. Ficarra V., Novara G., Artibani W. et al. Retropubic, laparoscopic, and robotassisted radical prostatectomy: a systematic review and cumulative analysis of comparative studies. Eur Urol 2009;55(5):1037–63. DOI: 10.1016/j.eururo.2009.01.036.

4. Dalton D.P., Schaeffer A.J., Garnett J.E., Grayhack J.T. Radiographic assessment of the vesicourethral anastomosis directing early decatheterization following nervesparing radical retropubic prostatectomy. J Urol 1989;141(1):79–81 DOI: 10.1016/s0022-5347(17)40595-7.

5. Schatzl G., Madersbacher S., Hofbauer J. et al. The impact of urinary extravasation after radical retropubic prostatectomy on urinary incontinence and anastomotic strictures. Eur Urol 1999;36(3):187–90. DOI: 10.1159/000067995.

6. Koch M.O., Nayee A.H., Sloan J. et al. Early catheter removal after radical retropubic prostatectomy: long-term follow up. J Urol 2003;169:2170–2. DOI: 10.1097/01.ju.0000065860.16392.19.

7. Lepor H., Nieder A.M., Fraiman M.C. Early removal of urinary catheter after radical retropubic prostatectomy is both feasible and desirable. Urology 2001;58:425–9 DOI: 10.1016/s0090-4295(01)01218-3.

8. Patel R., Lepor H. Removal of urinary catheter on postoperative day 3 or 4 after radical retropubic prostatectomy. Urology 2003;61(1):156–60. DOI: 10.1016/s0090-4295(02)02105-2.

9. Tiguert R., Rigaud J., Fradet Y. Safety and outcome of early catheter removal after radical retropubic prostatectomy. Urology 2004;63:513–7. DOI: 10.1016/j.urology.2003.10.042.

10. Schuessler W.W., Schulam P.G., Clayman R.V., Kavoussi L.R. Laparoscopic radical prostatectomy: initial short-term experience. Urology 1997;50(6):854–7. DOI: 10.1016/S0090-4295(97)00543-8.

11. Binder J., Jones J., Bentas W., et al. Robot-assisted laparoscopy in urology. Radical prostatectomy and reconstructive retroperitoneal interventions. Urologe A 2002;41(2):144–9. DOI: 10.1007/s00120-002-0178-2.

12. Yanagida T., Koguchi T., Hata J. et al. Current techniques to improve outcomes for early return of urinary continence following robot – assisted radical prostatectomy. Fukushima J Med Sci 2014;60:1–13. DOI: 10.5387/fms.2013-25.

13. Zorn K.C., Trinh Q.D., Jeldres C. et al. Prospective randomized trial of barbed polyglyconate suture to facilitate vesico-urethral anastomosis during robot-assisted radical prostatectomy: time reduction and cost benefit. BJU Int 2012;109:1526–32. DOI: 10.1111/j.1464-410X.2011.10763.x.

14. Michl U., Tennstedt P., Feldmeier L. et al. Nerve-sparing surgery technique, not the preservation of the neurovascular bundles, leads to improved long-term continence rates after radical prostatectomy. Eur Urol 2016;69(4):584– 9. DOI: 10.1016/j.eururo.2015.07.037.

15. Khemees T.A., Novak R., Abaza R. Risk and prevention of acute urinary retention after robotic prostatectomy. J Urol 2013;189(4):1432–6. DOI: 10.1016/j.juro.2012.09.097.

16. Montgomery J.S., Gayed B.A., Daignault S. et al. Early urinary retention after catheter removal. Following radical prostatectomy predicts for future symptomatic urethral stricture formation. Urology 2007;70:324–7. DOI: 10.1016/j.urology.2007.03.075.

17. Alnazari M., Zanaty M., Ajib K. et al. The risk of urinary retention following robot-assisted radical prostatectomy and its impact on early continence outcomes. Can Urol Assoc J 2018;12(3): E121–5. DOI: 10.5489/cuaj.4649.

18. Moore K.N., Estey A. The early postoperative concerns of men after radical prostatectomy. J Adv Nurs 1999;29(5):1121–9 DOI: 10.1046/j.1365-2648.1999.00995.x.

19. Hollingsworth J.M., Rogers M.A., Krein S.L. et al. Determining the noninfectious complications of indwelling urethral catheters: a systematic review and metaanalysis. Ann Intern Med 2013;159(6):401–10 DOI: 10.7326/0003-4819-159-6-201309170-00006.

20. Nosov A.K., Reva S.A., Berkut M.V., Petrov S.B. Early removal of urethral catheter after endoscopic extraperitoneal radical prostatectomy. Onkourologiya = Cancer Urology 2019;15(2):53–63. (In Russ.). DOI: 10.17650/1726-9776-2019-15-2-53-63.

21. Novara G., Ficarra V., Rosen R.C. et al. Systematic review and meta-analysis of perioperative outcomes and complications after robot-assisted radical prostatectomy. Eur Urol 2012;62(3):431– 52. DOI: 10.1016/j.eururo.2012.05.044.

22. Tilki D., Preisser F., Karakiewicz P. et al. The impact of time to catheter removal on short-, intermediate- and long-term urinary continence after radical prostatectomy. World J Urol 2018;36(8):1247–53. DOI: 10.1007/s00345-018-2274-y.

23. Gratzke C., Dovey Z., Novara G. et al. Early catheter removal after robot-assisted radical prostatectomy: surgical technique and outcomes for the Aalst technique (ECaRemA study). Eur Urol 2016;69:917–23. DOI: 10.1016/j.eururo.2015.09.052.

24. Goonewardene S.S., Gillatt D., Persad R. A systematic review of PFE pre-prostatectomy. J Robot Surg 2018;12:397–400. DOI: 10.1007/s11701-018-0803-8.

25. Chang J.I., Lam V., Patel M.I. Preoperative pelvic floor muscle exercise and postprostatectomy incontinence: a systematic review and meta-analysis. Eur Urol 2016;69:460–7. DOI: 10.1016/j.eururo.2015.11.004.

26. Treanor C., Kyaw T., Donnelly M. An international review and meta-analysis of prehabilitation compared to usual care for cancer patients. J Cancer Surviv 2018;12:64–73. DOI: 10.1007/s11764-017-0645-9.

27. Straczynska A., Weber-Rajek M., Strojek K. et al. The impact of pelvic floor muscle training on urinary incontinence in men after radical prostatectomy (RP) – a systematic review. Clin Interv Aging 2019;14:1997–2005. DOI: 10.2147/CIA.S228222.

28. Wu M.L.Y., Wang C.S., Xiao Q. et al. The therapeutic effect of pelvic floor muscle exercise on urinary incontinence after radical prostatectomy: a metaanalysis. Asian J Androl 2019;21:170–6. DOI: 10.4103/aja.aja_89_18.

29. Sandhu J.S., Breyer B., Comiter C. et al. Incontinence after prostate treatment: AUA/SUFU guideline. J Urol 2019;202:369–78. DOI: 10.1097/JU.0000000000000314.