Department of Urology and Andrology, St. John of God Hospital Vienna, Krankenhaus der Barmherzigen Brüder Wien, Johannes-von-Gott Platz 1, 1020, Vienna, Austria.
Department of Urology, Paracelsus Medical University, Salzburg, Austria.
World J Urol. 2020 Sep;38(9):2177-2183. doi: 10.1007/s00345-019-03001-4. Epub 2019 Nov 14.
To compare prospectively early outcome and complications of catheter removal after robot-assisted radical prostatectomy (RARP) on the 4th or 7th day with a standardized running barbed suture technique.
The time point of removing the indwelling catheter after RARP mainly depends on institute's/surgeon's preferences. Removal should be late enough to avoid urinary leakage and complications such as acute urinary retention (AUR) but early enough to avoid unnecessary catheter indwelling.
A consecutive single-institutional series of patients underwent RARP between July 2015 and August 2017 and were entered in a prospectively maintained data base. Between July 2015 and December 2016 a cystogram was performed on 7th postoperative day (group A), thereafter the cystogram was performed on 4th postoperative day (group B). Incidence of acute urinary retention (AUR), urinary tract infections (UTI) and adverse events between the two cohorts was compared.
425 patients were analyzed (group A: n = 231; group B: n = 194). Both cohorts were comparable regarding demographic and oncological parameters. Watertight anastomosis was present in 84.8% in group A and in 82.5% in group B, respectively. AUR within 4 weeks after RARP occurred in 2.2% (n = 3) in A and 9.4% (n = 15) in B (p = 0.001). AUR within 72 h after catheter removal occurred in group A: 1% (n = 2) and in group B: 6.3% (n = 10) (p = 0.005). Symptomatic urinary tract infections occurred in 8.2% (n = 16) in group A and in 6.9% (n = 11) in group B. There were no differences in the rate of secondary anastomosis dehiscence. Age, BMI, prostate size, surgeon, or intraoperative bladder neck reconstruction were not correlated to the occurrence of AUR or UTI.
The removal of indwelling catheter on day 4 after a RARP with a running barbed suture shows similar anastomosis leakage rates as on the 7th postoperative day. However, AUR rates are higher for early removal. Patients scheduled for early removal should be carefully informed about the increased risk for AUR. Catheter indwelling time does not represent a risk factor for UTI.
前瞻性比较机器人辅助根治性前列腺切除术（RARP）后第 4 天或第 7 天用标准化的滑线缝合技术拔除导尿管的早期结果和并发症。
RARP 后拔除留置导尿管的时间点主要取决于机构/外科医生的偏好。拔除时间应足够晚以避免尿漏和急性尿潴留（AUR）等并发症，但也应足够早以避免不必要的留置导尿管。
2015 年 7 月至 2017 年 8 月，连续进行了一项单机构系列研究，患者接受了 RARP 并被纳入前瞻性维护的数据中。2015 年 7 月至 2016 年 12 月，第 7 天（A 组）行膀胱造影，此后第 4 天（B 组）行膀胱造影。比较两组患者的急性尿潴留（AUR）、尿路感染（UTI）和不良事件发生率。
分析了 425 例患者（A 组：n=231；B 组：n=194）。两组患者的人口统计学和肿瘤学参数均无差异。A 组中 84.8%的吻合口为水密，B 组为 82.5%。AUR 在 RARP 后 4 周内发生在 A 组的 2.2%（n=3）和 B 组的 9.4%（n=15）（p=0.001）。A 组中，AUR 在导尿管拔除后 72 小时内发生的比例为 1%（n=2），B 组为 6.3%（n=10）（p=0.005）。A 组中有 8.2%（n=16）和 B 组中有 6.9%（n=11）出现症状性尿路感染。年龄、BMI、前列腺大小、外科医生或术中膀胱颈部重建与 AUR 或 UTI 的发生无关。
使用滑线缝合技术，RARP 后第 4 天拔除导尿管与第 7 天拔除导尿管的吻合口漏率相似。然而，早期拔除导尿管的 AUR 发生率更高。计划早期拔除导尿管的患者应仔细告知其 AUR 风险增加。导尿管留置时间不是 UTI 的危险因素。
