Evaluation of operative and postoperative outcomes of foley catheter free robotic-assisted radical prostatectomy

Thursday, September 15, 2022

3:00 PM – 3:10 PM East Coast USA Time

Location: JW Grand Ballroom 8

Reference 1: NOGUCHI, M. A. S. A. N. O. R. I., SHIMADA, A. K. I. H. I. K. O., YAHARA, J. Y. U. N. R. O., SUEKANE, S. H. I. G. E. T. A. K. A., & NODA, S. H. I. N. S. H. I. (2004). Early catheter removal 3 days after radical retropubic prostatectomy. International Journal of Urology, 11(11), 983–988. https://doi.org/10.1111/j.1442-2042.2004.00935.x
Reference 2: Tewari, A., Rao, S., & Mandhani, A. (2008). Catheter-less robotic radical prostatectomy using a custom-made synchronous anastomotic splint and vesical urinary diversion device: Report of the initial series and perioperative outcomes. BJU International, 102(8), 1000–1004. https://doi.org/10.1111/j.1464-410x.2008.07875.x
Reference 3: Tilki, D., Preisser, F., Karakiewicz, P., Shariat, S. F., Graefen, M., Huland, H., Chun, F. K., & Pompe, R. S. (2018). The impact of time to catheter removal on short-, intermediate- and long-term urinary continence after radical prostatectomy. World Journal of Urology, 36(8), 1247–1253. https://doi.org/10.1007/s00345-018-2274-y

Primary Presenter(s)

Zachariah Taylor, DO

Urology Resident
Main Line Health

Disclosure(s): No financial relationships to disclose

Author(s)

BT

Brian Thomas

Rowan University

Disclosure information not submitted.
SM

Sami Musallam, DO

Main Line Health Bryn Mawr Hospital - Bryn Mawr, PA

Disclosure information not submitted.
IZ

Ilia Zeltser, MD, FACS

Main Line Health Bryn Mawr Hospital - Bryn Mawr, PA

Disclosure information not submitted.

Disclosure(s):

Zachariah Taylor, DO: No financial relationships to disclose

Introduction/Purpose: Traditionally, the utilization of stents or catheters to ensure patency and optimal healing of anastomosis has been thought to be linked to lower rates of associated postoperative complications such as stricture, anastomotic leak or failure, and uroma formation, among others. Though it follows that the successful coupling of two tubular structures would be well-served by a surgically introduced supporting scaffold, this concept is supported by tradition and lacks evidence. In particular, for urethral anastomosis, scant evidence supports the necessity of catheter placement. We aim to analyze postoperative complications in patients who have undergone radical prostatectomy with or without an indwelling urethral catheter after surgery.

Methods or Case Description:
This Institutional Review Board exempt approved study was performed through retrospective review of all patients between January 2020 and March 2022 undergoing robotic-assisted radical prostatectomy with or without indwelling urethral catheter placement.
Patient medical records were reviewed, and clinical and pathological characteristics were evaluated, including age at surgery; sex; body mass index (BMI); preoperative and postoperative radiation and/or chemotherapy; pathologic T and N stage; surgical margin status, pad use, and urinary symptoms.
An independent t-test was used to compare continuous variables, and Pearson’s chi-square test or Fisher’s exact test was used to compare categorical variables. All analyses were performed using R Statistical Software (v4.1.2; R Core Team 2021). Two-sided p-values < 0.05 were considered statistically significant.

Outcomes: A total of 92 patients underwent robotic prostatectomy from January 2020 to March 2022. Of those, 62 had both a post-operative foley catheter and a suprapubic catheter, while 30 only had a suprapubic catheter. There was no significant difference noted between the foley and no foley group in regards to age (64.0 vs 64.47, p=0.7666), BMI (28.39 vs 28.48, p=0.9278), ASA (2.32 vs 2.4, p=0.4970), or PSA (9.13 vs 10.4256, p=0.6284). Further, there was no difference in stage, node status, or positive margins between the two groups. In regards to postoperative complications, there were no significant differences in the rates of anastomotic leak (p=0.3261), ileus (p=0.2471), or postoperative incontinence (0.7932). Neither group had any incidence of bladder neck contracture or urethral stricture.

Conclusion: Catheterless urethral anastomosis demonstrated no significant difference in rates of stricture, leak, ileus, bladder neck contracture/stricture, or postoperative urinary symptoms. This study demonstrates that the omission of an indwelling urethral catheter following robot-assisted radical prostatectomy is a safe and feasible technique.
Learning Objectives:
Upon completion, participant will be able to understand the foley catheter free robotic-assisted radical prostatectomy technique
Upon completion, participant will be able to understand post operative outcomes and complications of our study population
Upon completion, participant will be able to understand differences in continence rates following foley catheter free robotic-assisted radical prostatectomy