Presentation Authors: Nina Harke*, Essen, Germany, Christian Wagner, Katarina Urbanova, Mustapha Addali, Jorn H. Witt, Gronau, Germany
Introduction: In former studies, suprapubic tube placement after radical prostatectomy has been shown to be equivalent to a transurethral catheterization concerning complication rates and stricture rates with potential benefits regarding patients&[prime] comfort. This prospective randomized trial elucidates the perioperative and long-term functional outcomes depending on type and duration of catheterization after robot-assisted radical prostatectomy.
Methods: 198 patients were randomized prospectively (May 2016-June 2017): a transurethral catheter was placed in the control group with micturition on postoperative day (POD) 5 (A), while a suprapubic tube (SPT) was used in group B and C. In B, micturition was allowed on POD 5, in C on POD 2. To investigate patient comfort, numeric rating scale for movement and rest was used and usage of pain medication. Functional outcomes were evaluated with a 12- hour Pad test, residual volume analysis on POD 5 (A, B) and POD 2 (C), usage of pads after 4 weeks and up to 12 months and IPSS.
Results: After drop-out of 11 patients, no statistically significant differences could be found in patients&[prime] characteristics, perioperative or tumor-related data. Median overall bother was comparable for periods of movement (NRS for A: 2.4; B: 2.1; C: 2.2; p=0.39) and for rest (NRS for A: 1.4; B: 1.4; C: 1.2; p=0.80) with similar intake of pain medication, p=0.07. No differences could be observed in catheter related complications (p=0.86) and prolonged catheterization time occurred in six patients (A: 3; B: 1; C: 2; p=0.61). Median residual urine volume after removal of the catheter was 17 ml for A, 7 ml for B and 11 ml for C (p=0.07). A significantly better continence was observed for group C with 14 ml vs. 30 ml (A) and 24 ml (B) in the 12-hour PAD test on the day of catheter removal, p=0.007. After four weeks, 63% of the patients in C were continent (defined as use of no pad/day) compared to 33% in A and 41% in B, p=0.004. After 12 months, 76% patients were continent in A, 87% in B and 94% in C, p=0.023.
Conclusions: Suprapubic tube placement instead of transurethral catheterization in robot-assisted radical prostatectomy can be performed safely without an increased risk of perioperative complications. Early micturition starting on postoperative day 2 seems to be beneficial concerning short-term as well as long-term continence.