Prostate CancerImpact of Percutaneous Suprapubic Tube Drainage on Patient Discomfort after Radical Prostatectomy
Introduction
Radical prostatectomy (RP) is an effective treatment option for men with clinically localized prostate cancer (PCa), offering durable long-term survival and functional outcomes [1], [2]. Although some of the morbidity associated with RP can be reduced with minimally invasive approaches [3], [4], many men still find that the urethral catheter remains a cause of patient discomfort postoperatively [5].
The objective of this study was to examine the feasibility of draining the bladder with a percutaneous suprapubic tube (PST) after robotic-assisted laparoscopic radical prostatectomy (RALP) and to examine whether such a technique would result in decreased postoperative discomfort. In this study, we describe the technique of PST placement and detail complications resulting from the procedure. Specifically, urologic teaching has long held that urethral anastomoses should always be bridged with a urethral catheter; otherwise, mucosal cross-healing and stricture formation may occur. Does this dictum hold true in the presence of a precise mucosa-to-mucosa anastomosis, as is performed robotically?
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Patients
The first phase of the study consisted of quantifying the discomfort patients had after RALP. Utilizing the Faces Pain Score-Revised (FPS-R) version of the Visual Analog Scale (VAS), we evaluated postoperative discomfort in 50 consecutive patients undergoing RALP with urethral catheters in December 2007. Following this phase, 202 men undergoing RALP between February and August 2008 were offered the option of PST placement for bladder drainage. Informed consent, specifically explaining that
Results
Table 1 shows the demographic criteria of control and study patients. There was no difference between the two groups in age, preoperative prostate-specific antigen (PSA), IPSS, or Sexual Health Inventory for Men (SHIM) scores, prostate weight, tumor grade, or stage.
The mean operative time for the patients undergoing urethral catheterization was 171 min. Table 2 shows the range of postoperative pain scores in these patients. The median FPS-R score was 4 (interquartile range [IQR]: 2–5) on the
Discussion
Discomfort associated with urethral catheterization is a significant source of morbidity following RALP. Lepor et al found that 54% of patients reported moderate or severe physical limitations associated with urethral catheterization [10]. Other authors have hypothesized that urethral catheterization may play a role in exacerbating postoperative inflammation at the urethrovesical anastomosis, promoting development of bladder neck or urethral strictures [11]. In a meta-analysis of patients
Conclusions
We describe a simple technique of percutaneous suprapubic catheter drainage at the time of RALP. Suprapubic catheterization can be accomplished without increased perioperative morbidity. In our hands, it is associated with less patient discomfort than with urethral catheterization. The procedure can be performed with minimal complications. Continence rates are excellent but no better than with conventional urethral drainage. At 6–12-mo of follow-up, there is no greater incidence of anastomotic
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