Early Catheter Removal after Robot-assisted Radical Prostatectomy: Surgical Technique and Outcomes for the Aalst Technique (ECaRemA Study)

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• 作者：Christian Gratzke^b ; ^c ; ^{christian.gratzke@med.uni-muenchen.de" class="auth_mail" title="E-mail the corresponding author} ; Zach Dovey^c ; Giacomo Novara^c ; ^d ; Nicolas Geurts^a ; Ruben De Groote^a ; Peter Schatteman^a ; Geert de Naeyer^a ; Giorgio Gandaglia^a ; ^c ; ^e ; Alexandre Mottrie^a ; ^c
• 关键词：Anastomosis ; Continence ; Posterior reconstruction ; Prostate cancer ; Robot-assisted radical prostatectomy
• 刊名：European Urology
• 出版年：2016
• 出版时间：May 2016
• 年：2016
• 卷：69
• 期：5
• 页码：917-923
• 全文大小：548 K

文摘

Robot-assisted radical prostatectomy (RARP) is a widespread option for the treatment of patients with clinically localised prostate cancer. Modifications in the surgical technique may help to further improve functional outcomes.

Objective

To assess the outcome of early catheter removal 48 h after surgery, as opposed to standard catheter removal 6 d after surgery following RARP, using a newly developed surgical technique for posterior reconstruction and anastomosis (Aalst technique).

Design, setting, and participants

Patients scheduled for RARP were prospectively scheduled for early catheter removal at postoperative d 2 (group A, n = 37) and standard catheter removal at postoperative d 6 (group B, n = 37).

Surgical procedure

RARP was performed using the Da Vinci Si system. The Aalst technique for the urethro-vesical anastomosis including posterior reconstruction was used as previously described.

Outcome measurements and statistical analysis

The primary endpoint was spontaneous voiding after catheter removal. Secondary endpoints were rate of anastomotic urinary leakage after catheter removal, presence and severity of urethral, perineal, and abdominal pain, as well as patient's bother after catheter removal using visual analogue scale (VAS) scores. Rate and severity of urinary incontinence after catheter removal were assessed using the International Consultation on Incontinence Questionnaire-Male Lower Urinary Tract Symptoms Module (ICIQ-MLUTS) questionnaire.

Results and limitations

There was no significant difference between the groups with regard to baseline and perioperative parameters, as well as pathological features; however, significantly more patients underwent bilateral nerve-sparing procedures in group A (34 vs 23, p = 0.008). After catheter removal, patients in both groups showed spontaneous voiding, whereas only 11% and 8% of the patients in group A and group B experienced urinary retention after catheter removal (p = 0.7). Patients in group B had significantly higher maximum flow rates, but lower voided volumes after catheter removal in comparison with patients in group A (21 ml/s vs 10 ml/s, p ≤ 0.001 and 170 ml vs 200 ml, p ≤ 0.001, respectively). ICIQ-MLUTS questionnaire and VAS scores showed no significant differences between the groups at any time point.

Conclusions

The Aalst technique allows the removal of catheters 2 d after RARP and results in spontaneous voiding. Early removal showed no increased rate of urinary leakage, no negative impact on short-term continence and on perineal, urethral or penile pain, and no increase in urinary retention rates. Future studies have to confirm these results with longer follow-up including detailed parameters on return to daily activity.

Patient summary

We provide evidence that it is possible to remove the bladder catheter as early as 2 d after robot-assisted radical prostatectomy without any negative effects on voiding and pain parameters. Thus, leaving the hospital early without a catheter in place could represent a significant and relevant benefit for the patient.