Tiguert Rabi, Rigaud Jérôme, Fradet Yves
Department of Urology, Laval University Cancer Research Center, Centre Hospitalier Universitaire de Québec, L'Hôtel Dieu de Québec, Québec, Canada.
Urology. 2004 Mar;63(3):513-7. doi: 10.1016/j.urology.2003.10.042.
To assess the outcomes of patients who underwent radical retropubic prostatectomy (RRP) and had their indwelling urinary catheter removed on postoperative day 4 or later.
The medical records of 342 consecutive patients undergoing RRP by a single surgeon were retrospectively reviewed. None of these patients had received radiotherapy, transurethral resection, or simple prostatectomy before RRP. The 342 patients were categorized into two groups according to the length of catheterization. Group 1 (n = 127) had the urethral catheter removed on postoperative day 4, and group 2 (n = 215) had the catheter removed later than postoperative day 4. Removal of the urinary catheter was only done if control cystography failed to demonstrate anastomotic extravasation. In the case of acute urinary retention, home care nurses and emergency room personnel reinserted the urinary catheter without cystoscopic assistance. Incontinence was rated according to the number of protective pads used in a 24-hour period as follow: none, mild (1 pad/day), moderate (more than 1 but 3 or fewer pads/day), and severe (more than 3 pads/day).
The mean age of the study population was 61.5 +/- 6.1 years. Acute urinary retention after catheter removal occurred in 11 patients (3%), 4 from group 1 and 7 from group 2. None of the patients requiring catheter reinsertion presented with complications related to this event. The overall continence rate was 58%, 85%, and 92% at 3, 9, and 12 months, respectively. The continence rates at 3, 9, and 12 months were higher for group 1 than for group 2 (P = 0.0002, P = 0.011, and P = 0.044, respectively). Bladder neck contracture was encountered in 14 patients (4%), 2 (2%) from group 1 and 12 (6%) from group 2. The only factor predicting continence was the duration of bladder catheterization.
Bladder catheters can be safely removed on postoperative day 4 in patients with normal cystograms after RRP. The continence and anastomotic stricture rates were improved in patients with 4 days of indwelling catheterization.
评估接受耻骨后根治性前列腺切除术（RRP）且术后第4天或更晚拔除留置导尿管的患者的预后。
回顾性分析了由同一外科医生连续进行RRP的342例患者的病历。这些患者在RRP之前均未接受过放疗、经尿道切除术或单纯前列腺切除术。根据导尿时间长短将342例患者分为两组。第1组（n = 127）在术后第4天拔除尿道导尿管，第2组（n = 215）在术后第4天以后拔除导尿管。仅在膀胱造影检查未显示吻合口外渗时才拔除导尿管。对于急性尿潴留，家庭护理护士和急诊室工作人员在无膀胱镜辅助的情况下重新插入导尿管。根据24小时内使用的护垫数量对尿失禁进行分级，如下：无、轻度（每天1片护垫）、中度（每天超过1片但3片或更少护垫）和重度（每天超过3片护垫）。
研究人群的平均年龄为61.5±6.1岁。拔除导尿管后急性尿潴留发生在11例患者（3%）中，第1组4例，第2组7例。需要重新插入导尿管的患者均未出现与此事件相关的并发症。3个月、9个月和12个月时的总体控尿率分别为58%、85%和92%。第1组在3个月、9个月和12个月时的控尿率高于第2组（分别为P = 0.0002、P = 0.011和P = 0.044）。14例患者（4%）出现膀胱颈挛缩，第1组2例（2%），第2组12例（6%）。唯一预测控尿的因素是膀胱导尿持续时间。
RRP后膀胱造影正常的患者可在术后第4天安全拔除膀胱导尿管。留置导尿管4天的患者控尿率和吻合口狭窄率有所改善。
