Early versus standard catheter removal after complete anatomical reconstruction during robot-assisted radical prostatectomy: results from a prospective single-institutional randomized trial (RIPRECA)
To evaluate urinary retention rate, discomfort and postoperative functional outcomes of early (3rd postoperative day, POD) vs standard catheter removal (5th POD) in patients treated with robot assisted prostatectomy (RARP) for clinically localized prostate cancer (PCa)
A prospective randomized trial was conducted from Sept 2016 to May 2017 at our Institution. Patients candidated for RARP were randomized into two groups (Group A: 3rd POD catheter removal vs. Group B: 5th POD catheter removal). Exclusion criteria consisted of previous urethral or prostate surgery. All patients received a complete anatomical reconstruction where both posterior and anterior layers were recreated. Patients with intraoperative negative anastomosis leakage test (with 250 cc of saline mixed with methylene blu) were included. Urinary retention rate after catheter removal was recorded. Functional outcomes were evaluated with administration of the following questionnaires at dismissal and at 1, 3 and 6 months: ICIQ-M-LUTS, IPSS, IIEF5. Postoperative discomfort was quantified with abdominal, urethral and perineal VAS score at dismissal and 1 month after surgery. Finally, early urinary continence rate was assessed with PAD test at dismissal and at 1 month.
Overall 77 (50.3%) and 76 (49.7%) underwent early and standard catheter removal respectively. Urinary retention was experienced in 3 (3.9%) and 1 (1.3%) cases in group A and B respectively (p=0.3). Continence rate at dismissal was 53.3% (n 41) and 46% (n 35) in group A and B (p=0.4) while at 1 month was 72% (n 55) and 76% (n 58) in group A and B (p=0.5) respectively. ICIQ mLUTS voiding and incontinence score at dismissal (p=0.75 and 0.12) and at 1 months (p=0.8 and 0.11) showed no differences between the two groups. Median ICIQ MLUTS voiding symptoms and IPSS score were comparable at 3 (p=0.38 and 0.56) and 6 months (p=0.18 and 0.17). Conversely, urethral discomfort at dismissal was significantly higher (p=0.02) in patients who underwent standard catheter removal. At 1 month uroflowmetry, median maximum flow rate was comparable between group A and B (17 vs 18 ml/s; p=0.29) while median voided volume was higher for 5th POD catheter removal group (179 vs 234 ml; p=0.05)
Early catheter removal represents a feasible and safe option in patients treated with RARP and complete anatomical reconstruction. Our findings may promote the adoption of this strategy in order to decrease hospital stay and patient discomfort