Elsevier

European Urology

Volume 56, Issue 2, August 2009, Pages 325-331
European Urology

Prostate Cancer
Impact of Percutaneous Suprapubic Tube Drainage on Patient Discomfort after Radical Prostatectomy

https://doi.org/10.1016/j.eururo.2009.04.018Get rights and content

Abstract

Background

Patients undergoing radical prostatectomy (RP) traditionally require urethral catheterization for adequate bladder drainage in the postoperative period. However, many patients have significant discomfort from the urethral catheter.

Objective

To describe a technique of percutaneous suprapubic tube (PST) bladder drainage after robotic-assisted laparoscopic radical prostatectomy (RALP) and to evaluate patient discomfort, complications, continence, and stricture rate after this procedure.

Design, setting, and participants

Two hundred two patients undergoing RALP were drained with a 14F PST instead of a urethral catheter. The PST was placed robotically at the conclusion of the urethrovesical anastomosis and secured to the skin over a plastic button. Beginning on postoperative day 5, patients clamped the PST, urinated per urethra, and measured the postvoid residual (PVR) drained by PST. The PST was removed when residuals were <30 cm3 per void. The control group consisted of 50 consecutive patients undergoing RALP with urethral catheter drainage.

Measurements

The primary end point was catheter-associated discomfort as measured with the Faces Pain Score-Revised (FPS-R). Secondary end points included use of anticholinergics, complications related to the PST, urinary continence, and urethral stricture.

Results and limitations

When compared with urethral catheter patients, PST patients had significantly decreased catheter-related discomfort on postoperative days 2 and 6 (p < 0.001). Anticholinergic medication was required by one PST and four urethral catheter patients (p < 0.001). Ten patients required urethral catheterization for PST dislodgement (n = 5) or urinary retention (n = 5). No patient has developed a urethral stricture at a mean follow-up of 7 mo.

Conclusions

PST provides adequate urinary drainage following RALP with less patient discomfort and no increased risk of urethral stricture.

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?

Section snippets

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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