ORIGINAL ARTICLE   Free access

Minerva Urologica e Nefrologica 2019 August;71(4):381-5

DOI: 10.23736/S0393-2249.19.03237-5

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Pain and discomfort after Retzius-sparing robot-assisted radical prostatectomy: a comparative study between suprapubic cystostomy and urethral catheter as urinary drainage

Antonio GALFANO ✉, Silvia SECCO, Daniele PANARELLO, Michele BARBIERI, Dario DI TRAPANI, Giovanni PETRALIA, Elena STRADA, Giancarlo NAPOLI, Aldo M. BOCCIARDI

Unit of Urology, Department of Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

BACKGROUND: The aim of this study is to evaluate differences in discomfort, complications and functional results after Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) according to different urinary drainage: suprapubic tube (SPT) and standard urethral catheter (UC).
METHODS: Prospective, comparative, consecutive, non-randomized study. In all patients with a water-tight anastomosis, no hematuria, obesity, previous suprapubic surgery or history of bladder cancer, a SPT (two-way Foley 14-Fr catheter) was positioned instead of a Foley 18-Fr UC. One week after surgery, an institutional self-compiled questionnaire was administered. The patients were divided into two groups according to the presence of UC or SPT and were compared concerning pain, perioperative results, complications, functional outcomes.
RESULTS: Fifty-six patients with UC and 135 with SPT agreed to participate to the study. Median postoperative pain score was 3 (IQR: 2-5) in UC and 3 (IQR: 1-5) in SPT group (P=0.324); urinary drain-related pain scores were 3 (IQR: 1-5) in UC and 1 (IQR: 0-3) in SPT groups (P<0.001); catheter removal related scores were 1 (IQR: 0-3) and 1 (IQR: 1-3) (P=0.317), respectively. Lastly, 17.8% (UC) and 31.1% (SPT) wore a protection (small or medium pad) while the urinary drainage was in place (P=0.061). No differences related to complications were found (P=0.085); 7.9% of patients in UC group and 4.2% in SPT group (P=0.178) used pads one year after surgery.
CONCLUSIONS: We demonstrated suprapubic tube to be more comfortable than transurethral catheter after RARP, with a possible advantage concerning anastomotic postoperative problems.

KEY WORDS: Cystostomy; Urinary catheters; Prostatectomy; Robotics; Postoperative pain