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Farahani M, Dehghani K, Shojaei P. Comparing the incidence of postoperative painful bladder spasm between malecot catheter and 3-way Foley catheter: a clinical trial. Ann Med Surg (Lond) 2024; 86:4488-4494. [PMID: 39118778 PMCID: PMC11305702 DOI: 10.1097/ms9.0000000000001913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/21/2024] [Indexed: 08/10/2024] Open
Abstract
Background In this study, the effect of Pezzer (as a Pezzer catheter) and three-way Foley catheters, used for suprapubic catheterization after open prostatectomy, was investigated in terms of early incidence of painful bladder spasms. Materials and methods In this single-blind clinical trial study, 160 patients diagnosed with LUTS/BPH were placed in two groups of 80 Pezzer catheter (Pezzer(size 28)) and three-way Foley catheters (size 24) for suprapubic catheterization. The evaluated variables in this study are age, prostate weight, narcotics dose, Spasm frequency, International Prostate Symptom Score (IPSS), visual analogue scale (VAS), catheterization period. Results The frequency of spasm in Foley group was significantly lower (4.4±7.26 vs. 6.28±4.4; P value=0.000). There was no significant difference between the two groups regarding the frequency of dysuria (P value=0.3). Conclusion The findings of our study showed that despite slightly favourable results in using suprapubic Foley catheter compared to Pezzer catheters in patients with open prostatectomy in terms of pain and spasm frequency, there was no significant difference between the use of these two types of catheters.
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Affiliation(s)
- Mojtaba Farahani
- General Practitioner, Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Keramat Dehghani
- Department of Urology, Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Parisa Shojaei
- Department of Community & Preventive Medicine, Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
- Social Determinants of Health Research Center, Tehran Islamic Azad University of Medical Sciences,Tehran, Iran
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Sasaki Y, Kusuhara Y, Oyama T, Nishiyama M, Kobayashi S, Daizumoto K, Tomida R, Ueno Y, Fukawa T, Yamaguchi K, Yamamoto Y, Takahashi M, Kanayama H, Furukawa J. Radical prostatectomy using the Hinotori robot-assisted surgical system: Docking-free design may contribute to reduction in postoperative pain. Int J Med Robot 2024; 20:e2648. [PMID: 38824454 DOI: 10.1002/rcs.2648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 05/01/2024] [Accepted: 05/24/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND The docking-free design of the Japanese Hinotori surgical robotic system allows the robotic arm to avoid trocar grasping, thereby minimising excessive abdominal wall stress. The aim of this study was to evaluate the safety and efficacy of robotic-assisted radical prostatectomy (RARP) using the Hinotori system and to explore the potential contribution of its docking-free design to postoperative pain reduction. METHODS This study reviewed the clinical records of 94 patients who underwent RARP: 48 patients in the Hinotori group and 46 in the da Vinci Xi group. RESULTS Hinotori group had significantly longer operative and console times (p = 0.030 and p = 0.029, respectively). Perioperative complications and oncologic outcomes did not differ between the two groups. On postoperative day 4, the rate of decline from the maximum visual analogue scale score was marginally significant in the Hinotori group (p = 0.062). CONCLUSIONS The docking-free design may contribute to reducing postoperative pain.
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Affiliation(s)
- Yutaro Sasaki
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yoshito Kusuhara
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Takuro Oyama
- Department of Anesthesiology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Mitsuki Nishiyama
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Saki Kobayashi
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Kei Daizumoto
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Ryotaro Tomida
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yoshiteru Ueno
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Tomoya Fukawa
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Kunihisa Yamaguchi
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yasuyo Yamamoto
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Masayuki Takahashi
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | | | - Junya Furukawa
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
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Taylor Z, Snow Z, Musallam S, Thomas B, Zeltser I. Is Urethral Catheterization Necessary in Retzius-sparing Robot-assisted Radical Prostatectomy? Urology 2023; 182:133-135. [PMID: 37742850 DOI: 10.1016/j.urology.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 09/03/2023] [Accepted: 09/12/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVE To analyze whether urethral catheter (UC)-free anastomosis during Retzius-sparing radical prostatectomy (RP) results in worsening immediate perioperative and postoperative complications. METHODS We retrospectively reviewed records of patients undergoing robotic-assisted RP with or without indwelling UC placement by a single surgeon between January 2020 and March 2022. Clinical and pathological characteristics were evaluated. An independent t-test was used to compare continuous variables, and Pearson's chi-square test or Fisher exact test was used to compare categorical variables. RESULTS One hundred fifteen patients underwent robotic prostatectomy from January 2020 to June 2022. Sixty-two patients had both a UC for 12 hours postoperatively and a suprapubic catheter for 6days, while in 53 patients a UC was omitted. There was no significant difference noted between the groups regarding age, body mass index, American Society of Anesthesiology score, prostate-specific antigen, stage, node status, or positive margins. There were no significant differences in the rates of anastomotic leak, ileus, or urethral stricture. Patients had a significantly higher pad-free rate in the suprapubic catheter-only group (P = .04) at 3months. There was no difference in average number of pads used or the number using more than 1 pad/day. CONCLUSION Omission of urethral catheterization during Retzius-sparing RP is safe and doesn't result in an increased risk in perioperative or postoperative complications, but rather appears to be associated with a significantly improved 3-month pad-free rate.
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Affiliation(s)
| | - Zachary Snow
- Main Line Health System, MidLantic Urology, Wynnewood, PA
| | - Sami Musallam
- Main Line Health System, MidLantic Urology, Wynnewood, PA
| | - Brian Thomas
- Main Line Health System, MidLantic Urology, Wynnewood, PA
| | - Ilia Zeltser
- Main Line Health System, MidLantic Urology, Wynnewood, PA
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4
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Wang T, Ji S, Zhang C, Xiang Y, Yin G. Effect of different catheter pathways on wounds after minimally invasive radical prostatectomy: A meta-analysis. Int Wound J 2023; 21:e14443. [PMID: 37905390 PMCID: PMC10828124 DOI: 10.1111/iwj.14443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 10/02/2023] [Indexed: 11/02/2023] Open
Abstract
Prostate cancer is one of the most common malignancies worldwide and the fifth leading cause of cancer deaths in men. With the rapidly increasing surgical rate of minimally invasive radical prostatectomy, there is still controversy about how to use a urinary catheter post-operatively. Thus, we attempted to compare the post-operative wound-related outcomes through a meta-analysis of urethral catheterisation (UC) versus suprapubic catheterisation (SPC) after minimally invasive radical prostatectomy. As of August 2023, the authors conducted systematic searches in databases such as PubMed, Embase, Web of Science and the Cochrane Library. The authors reviewed the relevant literature separately to determine comparisons between SPC and UC treatment after radical prostatectomy. A total of 395 subjects were enrolled in the five trials, met the eligibility criteria and were included in the meta-analysis. Data collection and analysis revealed significant differences in catheter bother to patients for surgical trauma (MD, 0.98; 95% CI, 0.48, 1.48 p = 0.0001), with SPC causing less catheter bother to patients post-operatively; post-operative catheter-related problems (OR, 3.3; 95% CI, 0.03, 326.1 p = 0.61), the POD1 of the post-operative period (MD, - 0.09; 95% CI, -0.75, 0.94 p = 0.83) and the POD3 of the post-operative period (MD, -0.49; 95% CI, -0.99, 0.01 p = 0.06); there was no statistically significant difference in wound pain. Compared with UC, SPC patients had less post-operative catheter distress. Thus, SPC is more beneficial in reducing post-operative wound discomfort in patients. The validity of the results remains to be tested in more and better studies.
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Affiliation(s)
- Tao Wang
- Department of UrologyWuhan Hankou HospitalWuhanChina
| | - Shiben Ji
- Department of UrologyWuhan Hankou HospitalWuhanChina
| | - Ci Zhang
- Department of UrologyZhongNan Hospital of Wuhan UniversityWuhanChina
| | - Yang Xiang
- Department of UrologyWuhan Hankou HospitalWuhanChina
| | - Guohong Yin
- Department of UrologyWuhan Hankou HospitalWuhanChina
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5
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Krausewitz P, Farzat M, Ellinger J, Ritter M. Omitting routine cystography after RARP: Analysis of complications and readmission rates in suprapubic and transurethral drained patients. Int J Urol 2023; 30:211-218. [PMID: 36305814 DOI: 10.1111/iju.15089] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 10/16/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Robot-assisted radical prostatectomy (RARP) has become the therapy of choice for local treatment of prostate cancer. Postoperatively, urologists perform cystography before removing urinary catheters due to concerns about the integrity of the vesicourethral anastomosis. This study aims to evaluate the safety of waiving cystography before early catheter removal after RARP. METHODS A total of 514 patients from two tertiary referral centers who underwent RARP were retrospectively included. Patients received postoperative urinary drainage by transurethral (TUC) or suprapubic catheter (SPC). During the first year, both centers performed routine cystography before removing TUC or SPC on postoperative day 5. In the following year, management changed and catheters were removed without cystography unless indicated by the surgeon. Demographic and perioperative data were analyzed. Postoperative complications and readmission rates were compared between standard cystography (StCG), no cystography (NCG), and selective cystography (SCG). RESULTS Groups were comparable regarding demographic and oncological parameters. Analysis showed no significant difference regarding major complications and readmission rates between standard and no cystography (p = 0.155 and 0.998 respectively). Omitting routine cystography did not lead to inferior postoperative courses regardless of both urinary drainage used and tumor stage. Subgroup analysis showed an increase of major complications in SCG patients when compared with NCG (p = 0.003) while readmissions remained comparable (p = 0.554). CONCLUSION Waiving routine cystography before early catheter removal after RARP appears to be safe and feasible regardless of urinary drainage. However, the selective cystogram at the surgeon's request still plays a role in monitoring patients with an elevated risk profile.
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Affiliation(s)
- Philipp Krausewitz
- Department of Urology and Pediatric Urology, University Hospital Bonn, Bonn, Germany
| | - Mahmoud Farzat
- Department of Urology, Diakonie Klinikum Siegen, Academic Teaching Hospital of the University of Bonn, Bonn, Germany
| | - Jörg Ellinger
- Department of Urology and Pediatric Urology, University Hospital Bonn, Bonn, Germany
| | - Manuel Ritter
- Department of Urology and Pediatric Urology, University Hospital Bonn, Bonn, Germany
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Demus T, Lopategui DM, Vieweg J, Masel J, Bhandari A, Nieder AM. Variations in Opioid Use Following Robotic Radical Prostatectomy in South Florida. J Endourol 2022; 36:1532-1537. [PMID: 35856823 DOI: 10.1089/end.2022.0212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Introduction: Opioid dependency has been a persistent issue in the United States over the past two decades. Increased efforts have been made to reduce opioid prescribing. Our objective was to quantify at-home opioid requirements following radical prostatectomy. Methods: Written questionnaires were administered to patients 1 week following robot-assisted laparoscopic radical prostatectomy (RALP). Patients provided data on opioid use, pain levels, and demographic characteristics. Results: Sixty-five patients were included. Median age (interquartile range [IQR]) was 69 (62-72) years. The majority were white (85%) and hispanic (67%). Prescriptions ranged from 6 to 15 pills of 5-mg oxycodone equivalents. Twenty-two percent (145/663) of the prescribed pills in the study were consumed. Fifty-four percent (35/65) of patients did not take opioids. Of the 30 patients who took opioids, median use (IQR) was 4.5 (3-6) pills. Forty-six percent (30/65) reported catheter-related pain. Patients who took opioids reported higher levels of pain. On generalized linear regression, younger age, lower levels of education, and living with a family member were factors associated with increased risk for opioid use (all p < 0.05). Conclusions: Despite the Florida Department of Health's restriction on narcotic prescriptions to 3-day supplies, opioids are still overprescribed in our region. The majority of patients do not require opioids after RALP, and patients who do require an opioid analgesic can be adequately managed with less than 6 pills of 5-mg oxycodone equivalents.
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Affiliation(s)
- Timothy Demus
- Department of Urology, Mount Sinai Medical Center, Miami Beach, Florida, USA
| | - Diana M Lopategui
- Department of Urology, Mount Sinai Medical Center, Miami Beach, Florida, USA
| | - Johannes Vieweg
- Department of Surgery, Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Jonathan Masel
- Department of Urology, Memorial Healthcare System, Hollywood, Florida, USA
| | - Akshay Bhandari
- Department of Urology, Mount Sinai Medical Center, Miami Beach, Florida, USA
| | - Alan M Nieder
- Department of Urology, Mount Sinai Medical Center, Miami Beach, Florida, USA
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7
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PROSPECT guidelines update for evidence-based pain management after prostatectomy for cancer. Anaesth Crit Care Pain Med 2021; 40:100922. [PMID: 34197976 DOI: 10.1016/j.accpm.2021.100922] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 02/03/2023]
Abstract
The aim of this review was to update the recommendations for optimal pain management after open and laparoscopic or robotic prostatectomy. Optimal pain management is known to influence postoperative recovery, but patients undergoing open radical prostatectomy typically experience moderate dynamic pain in the immediate postoperative day. Robot-assisted and laparoscopic surgery may be associated with decreased pain levels as opposed to open surgery. We performed a systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) with PROcedure SPECific Postoperative Pain ManagemenT (PROSPECT) methodology. Randomised controlled trials (RCTs) published in English language, from January 2015 until March 2020, assessing postoperative pain, using analgesic, anaesthetic and surgical interventions, were identified from MEDLINE, EMBASE and Cochrane Databases. Of the 1797 studies identified, 35 RCTs and 3 meta-analyses met our inclusion criteria. NSAIDs and COX-2 selective inhibitors proved to lower postoperative pain scores. Continuous intravenous lidocaine reduced postoperative pain scores during open surgery. Local wound infiltration showed positive results in open surgery. Bilateral transversus abdominis plane (TAP) block was performed at the end of surgery and lowered pain scores in robot-assisted procedures, but results were conflicting for open procedures. Basic analgesia for prostatic surgery should include paracetamol and NSAIDs or COX-2 selective inhibitors. TAP block should be recommended as the first-choice regional analgesic technique for laparoscopic/robotic radical prostatectomy. Intravenous lidocaine should be considered for open surgeries.
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8
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Suprapubic Versus Urethral Catheter for Urinary Drainage After Robot-Assisted Radical Prostatectomy. Curr Urol Rep 2020; 21:30. [PMID: 32506179 DOI: 10.1007/s11934-020-00982-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE OF REVIEW To review the evidence regarding the usage of suprapubic tube (SPT) versus indwelling urethral catheter (IUC) after robot-assisted radical prostatectomy (RARP). RECENT FINDINGS Available data on the use of SPT for urinary drainage after RARP is somewhat limited mostly because of the variations of study designs and non-standardized outcomes. Although it may provide some mild benefit in terms of catheter-related pain and discomfort, the benefit seems not to be clinically significant. The evidence in the literature so far does not support routine usage of SPT as the primary urinary drainage method after RARP. Further higher-quality studies that can show clinically significant advantages over IUC are still needed to justify its usage.
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9
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Harke NN, Wagner C, Liakos N, Urbanova K, Addali M, Hadaschik BA, Witt JH. Superior early and long-term continence following early micturition on day 2 after robot-assisted radical prostatectomy: a randomized prospective trial. World J Urol 2020; 39:771-777. [PMID: 32361875 DOI: 10.1007/s00345-020-03225-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 04/24/2020] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To elucidate early and long-term continence and patient comfort depending on type and duration of catheterization after robot-assisted radical prostatectomy. METHODS 198 patients were randomized prospectively into three groups (May 2016-July 2017): A transurethral catheter with micturition on postoperative day (POD) 5 was placed in the control group (TD5); a suprapubic tube (SPT) with micturition on POD 5 was placed in the group SD5 or with micturition on POD 2 in group SD2, respectively. Questionnaires were used for catheter-related satisfaction. Functional outcome analysis included residual volume analysis, uroflowmetry, IPSS, 12-h pad test, and daily pad use. Follow-up was conducted up to 12 months. RESULTS Postoperative comfort and catheter-related complications were similar in the three groups. However, on the day of catheter removal, continence was significantly better in the 12-h pad test for the SD2 group with 14 ml vs. 30 ml (TD5) and 24 ml (SD5), p = 0.007. Median residual urine volume between the groups was comparable with 17 ml in TD5, 7 ml in SD5, and 11 ml in SD2, (p = 0.07). Postoperative IPSS did not differ significantly in the follow-up period. After 4 weeks, 63% of the patients in SD2 were continent (no pad/day) compared to 33% in TD5 and 41% in SD5, p = 0.004. After 12 months, 76% were continent in TD5, 87% in SD5, and 94% in SD2, p = 0.023. CONCLUSIONS Early micturition after SPT placement in robotic radical prostatectomy seems to be beneficial without an increased risk of complications.
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Affiliation(s)
- Nina Natascha Harke
- Department of Urology, Pediatric Urology and Urologic Oncology, Prostate Center Northwest, St. Antonius Hospital, Moellenweg 22, 48599, Gronau, Germany.
| | - Christian Wagner
- Department of Urology, Pediatric Urology and Urologic Oncology, Prostate Center Northwest, St. Antonius Hospital, Moellenweg 22, 48599, Gronau, Germany
| | - Nikolaos Liakos
- Department of Urology, Pediatric Urology and Urologic Oncology, Prostate Center Northwest, St. Antonius Hospital, Moellenweg 22, 48599, Gronau, Germany
| | - Katarina Urbanova
- Department of Urology, Pediatric Urology and Urologic Oncology, Prostate Center Northwest, St. Antonius Hospital, Moellenweg 22, 48599, Gronau, Germany
| | - Mustapha Addali
- Department of Urology, Pediatric Urology and Urologic Oncology, Prostate Center Northwest, St. Antonius Hospital, Moellenweg 22, 48599, Gronau, Germany
| | - Boris A Hadaschik
- Department of Urology, Essen University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Jorn H Witt
- Department of Urology, Pediatric Urology and Urologic Oncology, Prostate Center Northwest, St. Antonius Hospital, Moellenweg 22, 48599, Gronau, Germany
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10
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Li Z, Li K, Wu W, Wang Q, Ma X, Lin C, Peng S, Lai Y, Wang F, Huang H. The comparison of transurethral versus suprapubic catheter after robot-assisted radical prostatectomy: a systematic review and meta-analysis. Transl Androl Urol 2019; 8:476-488. [PMID: 31807425 DOI: 10.21037/tau.2019.08.25] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background The transurethral catheter (TUC) or supra-pubic catheter is commonly used after robot-assisted radical prostatectomy (RARP). However, the best way of urine drainage after the operation is still controversial. Methods A comprehensive search of PubMed, Cochrane, Web of Science databases and the reference lists of relevant articles was performed up to July 2019. This systematic review and meta-analysis was performed based on all randomized controlled trials (RCTs) and retrospective studies assessing the two techniques. Results In total, nine studies (1,121 patients) were eligible, including three RCTs, one prospective and five retrospective studies. After RARP, postoperative pain was less in suprapubic catheter (SPC) group than TC group, both within 3 days [mean difference (MD): -0.70; 95% confidence interval (CI): -1.37 to -0.02; P=0.04] and 5 days after operation (MD: -0.96; 95% CI: -1.39 to -0.52; P<0.00001). There was no significant difference between SPC and TUC groups, in operation time (MD: 2.58; 95% CI: -5.82 to 10.97; P=0.55) and at rates of both catheterization-associated complication [odds ratio (OR): 1.05; 95% CI: 0.67 to 1.64; P=0.83] and long-term urinary incontinence (OR: 0.69; 95% CI: 0.42 to 1.12; P=0.13). Conclusions Patients in SPC group suffer from less postoperative pain compared with the TUC group. SPC can be a better alternate of TUC.
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Affiliation(s)
- Ze'an Li
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Kaiwen Li
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Wanhua Wu
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Qiong Wang
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Xiaoming Ma
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Chunhao Lin
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Shengmeng Peng
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Yiming Lai
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Fen Wang
- Center for Cancer and Stem Cell Biology, Institute of Biosciences and Technology, Texas A&M Health Science Center, Houston, TX 77030, USA
| | - Hai Huang
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Center for Cancer and Stem Cell Biology, Institute of Biosciences and Technology, Texas A&M Health Science Center, Houston, TX 77030, USA
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11
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Galfano A, Secco S, Panarello D, Barbieri M, Di Trapani D, Petralia G, Strada E, Napoli G, Bocciardi AM. Pain and discomfort after Retzius-sparing robot-assisted radical prostatectomy: a comparative study between suprapubic cystostomy and urethral catheter as urinary drainage. MINERVA UROL NEFROL 2019; 71:381-385. [PMID: 31144484 DOI: 10.23736/s0393-2249.19.03237-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
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.
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Affiliation(s)
- Antonio Galfano
- Unit of Urology, Department of Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy -
| | - Silvia Secco
- Unit of Urology, Department of Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Daniele Panarello
- Unit of Urology, Department of Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Michele Barbieri
- Unit of Urology, Department of Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Dario Di Trapani
- Unit of Urology, Department of Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giovanni Petralia
- Unit of Urology, Department of Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Elena Strada
- Unit of Urology, Department of Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giancarlo Napoli
- Unit of Urology, Department of Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Aldo M Bocciardi
- Unit of Urology, Department of Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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Li MX, Cheng P, Yao L, Li HJ, Xun YQ, Yan PJ, Han CW, Lu CC, He WB, Wang M, Liu R, Guo TK, Yang KH. Suprapubic tube compared with urethral catheter drainage after robot-assisted radical prostatectomy: A systematic review and meta-analysis. Asian J Surg 2019; 42:71-80. [DOI: 10.1016/j.asjsur.2018.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 08/15/2018] [Indexed: 10/28/2022] Open
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13
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Hwang EC, Risk MC, Dahm P. Suprapubic versus urethral catheter drainage in robotic-assisted laparoscopic prostatectomy: advancing systematic review quality. World J Urol 2018; 36:1501-1502. [PMID: 30006909 DOI: 10.1007/s00345-018-2372-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 06/08/2018] [Indexed: 01/08/2023] Open
Affiliation(s)
- Eu Chang Hwang
- Department of Urology, Chonnam National University Medical School, Gwangju, Republic of Korea.,Urology Section Minneapolis Veterans Healthcare System and Department of Urology, University of Minnesota, Minneapolis, MN, 55417, USA
| | - Michael C Risk
- Urology Section Minneapolis Veterans Healthcare System and Department of Urology, University of Minnesota, Minneapolis, MN, 55417, USA
| | - Philipp Dahm
- Urology Section Minneapolis Veterans Healthcare System and Department of Urology, University of Minnesota, Minneapolis, MN, 55417, USA.
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Supra-pubic versus urethral catheter after robot-assisted radical prostatectomy: systematic review of current evidence. World J Urol 2018; 36:1365-1372. [PMID: 29600334 DOI: 10.1007/s00345-018-2275-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 03/17/2018] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To provide latest evidence on the use of suprapubic catheter (SPC) versus urethral catheter (UC) after robot-assisted laparoscopic radical prostatectomy (RARP). MATERIALS AND METHODS A systematic revision of literature was performed up to September 2017 using different search engines (Pubmed, Ovid, Scopus) to identified studies comparing the use of SPC versus standard UC after RARP. Identification and selection of the studies were conducted according to the preferred reporting items for systematic reviews and meta-analysis criteria. For continuous outcomes, the weighted mean difference (WMD) was used as a summary measure, whereas the odds ratio (OR) or risk ratio (RR) with 95% confidence interval (CI) was calculated for binary variables. RR was preferred in cases of a high number of events to avoid overestimation. Pooled estimates were calculated using the random-effect model to account for clinical heterogeneity. All statistical analyses were performed using Review manager 5 (Cochrane Collaboration, Oxford, UK). RESULTS Eight studies were identified and included in this systematic review, namely 3 RCTs, 4 non-randomized prospective studies, and one retrospective study. A total of 966 RARP cases were collected for the cumulative analysis. Among them, 492 patients received standard UC and 474 SPC placement after RARP. UC patients had higher baseline PSA (WMD 0.44 ng/ml; p = 0.02). Visual Analog Scale (VAS) score was found to be significantly lower in patients with SPC at postoperative day 7 (WMD 0.53; 95% CI 0.13-0.93; p = 0.009). Regarding penile pain, a significant difference in favor of the SPC group was found at postoperative day 7 assessment (WMD 1.2; 95% CI 0.82-1.6; p < 0.001). More patients in the SPC group reported "not at all" or "minimal pain" at this time point (OR 0.17, 95% CI 0.06, 0.44; p < 0.001). No significant differences were found in terms of continence recovery rate at 6-12 weeks between the groups (UC 78.7%, 88.2%; RR 0.92, 95% CI 0.84, 1.01; p = 0.09). Similarly, no differences were found in terms of catheter-related issues (p = 0.17). However, UC patients had lower likelihood of overall complications (OR 0.44, 95% CI 0.21-0.89, p = 0.02). CONCLUSIONS Available evidence suggests that the use of SPC can be a viable option for postoperative urine drainage after RARP, as it can translate into decreased postoperative pain without carrying a significant higher risk of catheter-related complications. Further investigation seems to be warranted, ideally within the framework of a multicentre randomized study with standardized analysis of outcomes.
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Jian Z, Feng S, Chen Y, Wei X, Luo D, Li H, Wang K. Suprapubic tube versus urethral catheter drainage after robot-assisted radical prostatectomy: a systematic review and meta-analysis. BMC Urol 2018; 18:1. [PMID: 29304797 PMCID: PMC5756422 DOI: 10.1186/s12894-017-0312-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 12/19/2017] [Indexed: 02/05/2023] Open
Abstract
Background Prostate cancer is one of the most common cancers in the elderly population. The standard treatment is radical prostatectomy (RARP). However, urologists do not have consents on the postoperative urine drainage management (suprapubic tube (ST)/ urethral catheter (UC)). Thus, we try to compare ST drainage to UC drainage after robot-assisted radical prostatectomy regarding to comfort, recovery rate and continence using the method of meta-analysis. Methods A systematic search was performed in Dec. 2017 on PubMed, Medline, Embase and Cochrane Library databases. The authors independently reviewed the records to identify studies comparing ST with UC of patients underwent RARP. Meta-analysis was performed using the extracted data from the selected studies. Results Seven studies, including 3 RCTs, with a total of 946 patients met the inclusion criteria and were included in our meta-analysis. Though there was no significant difference between the ST group and the UC group on postoperative pain (RR1.73, P 0.20), our study showed a significant improvement on bother or discomfort, defined as trouble in hygiene and sleep, caused by catheter when compared two groups at postoperative day (POD) 7 in ST group (RR2.05, P 0.006). There was no significant difference between the ST group and UC group on urinary continence (RR0.98, P 0.74) and emergency department visit (RR0.61, P 0.11). The rates of bladder neck contracture and other complications were very low in both groups. Conclusion Compared to UC, ST showed a weak advantage. So it might be a good choice to choose ST over RARP.
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Affiliation(s)
- Zhongyu Jian
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Shijian Feng
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Yuntian Chen
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Xin Wei
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Deyi Luo
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Hong Li
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Kunjie Wang
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China.
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Brassetti A, Proietti F, Cardi A, De Vico A, Iannello A, Pansadoro A, Scapellato A, Riga T, Emiliozzi P, D'Elia G. Removing the urinary catheter on post-operative day 2 after robot-assisted laparoscopic radical prostatectomy: a feasibility study from a single high-volume referral centre. J Robot Surg 2017; 12:467-473. [PMID: 29177945 DOI: 10.1007/s11701-017-0765-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 11/19/2017] [Indexed: 11/28/2022]
Abstract
The indwelling urinary catheter (UC) is a significant bother for men after radical prostatectomy (RP) and should be removed as soon as possible without jeopardizing the outcome. Our aim was to assess the feasibility and safety of its removal on postoperative day (POD) 2 after robot-assisted laparoscopic RP (RALP). A consecutive series of patients undergoing RALP for localized prostate cancer (PCa) were prospectively enrolled. Inclusion criteria were: no bladder-neck reconstruction, watertight urethrovesical anastomosis at 150 ml filling, ≤ 200 ml of intraoperative bleeding, ≤ 80 ml of fluid from the drain on POD 1, clear urine from the UC on POD 2. Patients were discharged on POD 2. Continence was assessed at catheter removal and 1, 3 and 6 months after surgery. Urethrovesical anastomosis was performed with a standard technique on 3 layers. Sixty-six patients were enrolled. The UC was removed on POD 2 in all the cases and 96.4% of the patients were discharged on POD 2. Re-catheterization was needed 16 times and it was always performed easily. Twenty-four complications were reported by 20 patients, mostly Clavien-Dindo (CD) grade II; 2 CD IIIB complications were observed. No anastomotic strictures were diagnosed. At catheter removal, 29% of the patients were completely continent, 41% at 1 month, 67% at 3 months and 92% at 6 months. In selected patients, removing the UC 48 h after RALP is feasible and safe and has no negative impact on continence if compared with the best international standards.
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Affiliation(s)
- Aldo Brassetti
- Department of Urology, San Giovanni Hospital, Via dell'Amba Aradam 9, 00184, Rome, Italy.
| | - Flavia Proietti
- Department of Urology, La Sapienza University of Rome, Via di Grottarossa 1035, 00189, Rome, Italy
| | - Antonio Cardi
- Department of Urology, San Giovanni Hospital, Via dell'Amba Aradam 9, 00184, Rome, Italy
| | - Antonio De Vico
- Department of Urology, San Giovanni Hospital, Via dell'Amba Aradam 9, 00184, Rome, Italy
| | - Antonio Iannello
- Department of Urology, San Giovanni Hospital, Via dell'Amba Aradam 9, 00184, Rome, Italy
| | - Alberto Pansadoro
- Department of Urology, San Giovanni Hospital, Via dell'Amba Aradam 9, 00184, Rome, Italy
| | - Aldo Scapellato
- Department of Urology, San Giovanni Hospital, Via dell'Amba Aradam 9, 00184, Rome, Italy
| | - Tommaso Riga
- Department of Urology, San Giovanni Hospital, Via dell'Amba Aradam 9, 00184, Rome, Italy
| | - Paolo Emiliozzi
- Department of Urology, San Giovanni Hospital, Via dell'Amba Aradam 9, 00184, Rome, Italy
| | - Gianluca D'Elia
- Department of Urology, San Giovanni Hospital, Via dell'Amba Aradam 9, 00184, Rome, Italy
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Postoperative patient comfort in suprapubic drainage versus transurethral catheterization following robot-assisted radical prostatectomy: a prospective randomized clinical trial. World J Urol 2016; 35:389-394. [PMID: 27334135 DOI: 10.1007/s00345-016-1883-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 06/13/2016] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To evaluate the impact of the type of urinary diversion (suprapubic vs. transurethral catheterization) on patients' postoperative pain after radical prostatectomy, development of bacteriuria and long-term functional results. METHODS A randomized, prospective clinical trial was performed including 160 patients who underwent robot-assisted radical prostatectomy after randomization into two groups: intraoperatively, a transurethral catheter (control group) or an additional suprapubic tube (with removal of the transurethral catheter in the morning of postoperative day 1; intervention group) was placed. Primary study endpoint was postoperative pain objectified by the numeric rating scale questionnaire. Secondary endpoints were bacteriuria after catheter removal and functional outcomes after up to 2 years of follow-up. RESULTS There were no significant differences in demographic and perioperative data. Starting on postoperative day 2, patients in the suprapubic diversion group had significantly less pain on every time point preceding the removal of the catheter compared to the control cohort with a median overall numeric rating score on postoperative day 1-4 of 2.4 points in the transurethral versus 1.3 in the intervention group (p = 0.012). No statistical difference was found in postoperative bacteriuria and complications as well as in functional results, quality of life and incontinence rates after a median follow-up of 22 months. CONCLUSIONS Suprapubic drainage in robot-assisted radical prostatectomy shows significantly decreased pain levels during the catheterization period compared to the transurethral diversion without compromising long-term functional results. Intraoperative placement of a suprapubic tube should be discussed as a standard procedure for further improvement of patients' postoperative comfort.
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Ficarra V, Crestani A, Rossanese M, Palumbo V, Calandriello M, Novara G, Praturlon S, Giannarini G. Urethral-fixation technique improves early urinary continence recovery in patients who undergo retropubic radical prostatectomy. BJU Int 2016; 119:245-253. [DOI: 10.1111/bju.13514] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Vincenzo Ficarra
- Urology Unit; Department of Experimental and Clinical Medical Sciences; University of Udine; Udine Italy
- Urology Unit; Academic Medical Centre Hospital Santa Maria della Misericordia; Udine Italy
| | - Alessandro Crestani
- Urology Unit; Academic Medical Centre Hospital Santa Maria della Misericordia; Udine Italy
| | | | - Vito Palumbo
- Urology Unit; Department of Oncologic, Surgical and Gastrointestinal Sciences; University of Padova; Padova Italy
| | - Mattia Calandriello
- Urology Unit; Academic Medical Centre Hospital Santa Maria della Misericordia; Udine Italy
| | - Giacomo Novara
- Urology Unit; Department of Oncologic, Surgical and Gastrointestinal Sciences; University of Padova; Padova Italy
| | - Silvio Praturlon
- Urology Unit; Academic Medical Centre Hospital Santa Maria della Misericordia; Udine Italy
| | - Gianluca Giannarini
- Urology Unit; Academic Medical Centre Hospital Santa Maria della Misericordia; Udine Italy
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Kidd EA, Stewart F, Kassis NC, Hom E, Omar MI. Urethral (indwelling or intermittent) or suprapubic routes for short-term catheterisation in hospitalised adults. Cochrane Database Syst Rev 2015; 2015:CD004203. [PMID: 26661940 PMCID: PMC8612698 DOI: 10.1002/14651858.cd004203.pub3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Indwelling urethral catheters are often used for bladder drainage in hospital. Urinary tract infection is the most common hospital-acquired infection, and a common complication of urinary catheterisation. Pain, ease of use and quality of life are important to consider, as well as formal economic analysis. Suprapubic catheterisation can also result in bowel perforation and death. OBJECTIVES To determine the advantages and disadvantages of alternative routes of short-term bladder catheterisation in adults in terms of infection, adverse events, replacement, duration of use, participant satisfaction and cost effectiveness. For the purpose of this review, we define 'short-term' as intended duration of catheterisation for 14 days or less. SEARCH METHODS We searched the Cochrane Incontinence Group Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE in process, ClinicalTrials.gov, WHO ICTRP and handsearching of journals and conference proceedings (searched 26 February 2015), CINAHL (searched 27 January 2015) and the reference lists of relevant articles. SELECTION CRITERIA We included all randomised and quasi-randomised trials comparing different routes of catheterisation for short-term use in hospitalised adults. DATA COLLECTION AND ANALYSIS At least two review authors extracted data and performed 'Risk of bias' assessment of the included trials. We sought clarification from the trialists if further information was required. MAIN RESULTS In this systematic review, we included 42 trials.Twenty-five trials compared indwelling urethral and suprapubic catheterisation. There was insufficient evidence for symptomatic urinary tract infection (risk ratio (RR) 1.01, 95% confidence interval (CI) 0.61 to 1.69; 5 trials, 575 participants; very low-quality evidence). Participants with indwelling catheters had more cases of asymptomatic bacteriuria (RR 2.25, 95% CI 1.63 to 3.10; 19 trials, 1894 participants; very low quality evidence) and more participants reported pain (RR 5.62, 95% CI 3.31 to 9.55; 4 trials, 535 participants; low-quality evidence). Duration of catheterisation was shorter in the indwelling urethral catheter group (MD -1.73, 95% CI -2.42 to -1.05; 2 trials, 274 participants).Fourteen trials compared indwelling urethral catheterisation with intermittent catheterisation. Two trials had data for symptomatic UTI which were suitable for meta-analysis. Due to evidence of significant clinical and statistical heterogeneity, we did not pool the results, which were inconclusive and the quality of evidence was very low. The main source of heterogeneity was the reason for hospitalisation as Hakvoort and colleagues recruited participants undergoing urogenital surgery; whereas in the trial conducted by Tang and colleagues elderly women in geriatric rehabilitation ward were recruited. The evidence was also inconclusive for asymptomatic bacteriuria (RR 1.04; 95% CI 0.85 to 1.28; 13 trials, 1333 participants; very low quality evidence). Almost three times as many people developed acute urinary retention with the intermittent catheter (16% with urethral versus 45% with intermittent); RR 0.45, 95% CI 0.22 to 0.91; 4 trials, 384 participants.Three trials compared intermittent catheterisation with suprapubic catheterisation, with only female participants. The evidence was inconclusive for symptomatic urinary tract infection, asymptomatic bacteriuria, pain or cost.None of the trials reported the following critical outcomes: quality of life; ease of use, and cost utility analysis. AUTHORS' CONCLUSIONS Suprapubic catheters reduced the number of participants with asymptomatic bacteriuria, recatheterisation and pain compared with indwelling urethral. The evidence for symptomatic urinary tract infection was inconclusive.For indwelling versus intermittent urethral catheterisation, the evidence was inconclusive for symptomatic urinary tract infection and asymptomatic bacteriuria. No trials reported pain.The evidence was inconclusive for suprapubic versus intermittent urethral catheterisation. Trials should use a standardised definition for symptomatic urinary tract infection. Further adequately-powered trials comparing all catheters are required, particularly suprapubic and intermittent urethral catheterisation.
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Affiliation(s)
- Emily A Kidd
- University of AberdeenCochrane Incontinence GroupHealth Sciences Building (second floor)AberdeenUKAB25 2ZD
| | - Fiona Stewart
- University of AberdeenAcademic Urology UnitForesterhillAberdeenScotlandUKAB25 2ZD
| | - Nadine C Kassis
- Toledo Clinic Urogynecology3425 Executive ParkwaySuite 108ToledoUSAOH 43606
| | - Emily Hom
- Baylor Scott and White Health2401 South 31st StreetMS‐01‐E316ATempleTXUSA76508
| | - Muhammad Imran Omar
- University of AberdeenAcademic Urology UnitForesterhillAberdeenScotlandUKAB25 2ZD
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Editorial Comment on: Percutaneous cystostomy drainage for early removing urethral catheter in robotic-assisted laparoscopic radical prostatectomy: improving on patient's discomfort. UROLOGICAL SCIENCE 2015. [DOI: 10.1016/j.urols.2015.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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21
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Morgan MSC, Ozayar A, Friedlander JI, Shakir N, Antonelli JA, Bedir S, Roehrborn CG, Cadeddu JA. An Assessment of Patient Comfort and Morbidity After Robot-Assisted Radical Prostatectomy with Suprapubic Tube Versus Urethral Catheter Drainage. J Endourol 2015; 30:300-5. [PMID: 26472083 DOI: 10.1089/end.2015.0206] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Robot-assisted laparoscopic prostatectomy (RALP) with suprapubic tube (SPT), compared to urethral catheter (UC) drainage, has been proposed to improve patient comfort and recovery. We sought to compare short-term outcomes for pain and morbidity after RALP with SPT vs UC drainage. METHODS Between August 2012 and 2014, 159 men underwent a RALP and prospectively completed a questionnaire addressing postoperative pain and satisfaction. Group 1 (n = 94) underwent a RALP by one surgeon who placed a UC and removed it between postoperative day (POD) 7 and 10. Group 2 (n = 65) underwent a RALP by a different surgeon who placed an SPT and UC. On POD 1, the UC was removed. On POD 9, the SPT was capped and removed on POD 11 if the patient was voiding adequately. Preoperative and intraoperative data, complications, questionnaires, and patient-reported morbidity, including unplanned telephone calls and emergency department (ED) visits, were compared between groups. RESULTS Patient characteristics were similar between groups. One week after surgery, the penile pain score was statistically significantly lower in Group 2 compared to Group 1 (56.9% and 79.8%, respectively, reported minimal-to-moderate pain, p = 0.003). Bladder spasms and overall pain were not significantly higher for Group 1 compared to Group 2 (p > 0.05). When asked "How big a problem has your urine storage device been?," 20.2% of patients in Group 1 reported it as a "moderate-to-big" problem compared to 10.8% in Group 2 (p > 0.05). The number of catheter-related unplanned telephone encounters did not differ between the two groups (p = 0.7), however, although not statistically significant, 4.6% of patients in Group 2 presented to the ED with catheter-related issues (p = 0.07). CONCLUSION SPT after RALP was associated with less penile pain compared to UC drainage, and modestly better patient satisfaction. There were no significant differences in bladder spasms, overall pain, and patient-reported morbidity between groups.
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Affiliation(s)
- Monica S C Morgan
- Department of Urology, University of Texas Southwestern Medical Center , Dallas, Texas
| | - Asim Ozayar
- Department of Urology, University of Texas Southwestern Medical Center , Dallas, Texas
| | - Justin I Friedlander
- Department of Urology, University of Texas Southwestern Medical Center , Dallas, Texas
| | - Nabeel Shakir
- Department of Urology, University of Texas Southwestern Medical Center , Dallas, Texas
| | - Jodi A Antonelli
- Department of Urology, University of Texas Southwestern Medical Center , Dallas, Texas
| | - Selahattin Bedir
- Department of Urology, University of Texas Southwestern Medical Center , Dallas, Texas
| | - Claus G Roehrborn
- Department of Urology, University of Texas Southwestern Medical Center , Dallas, Texas
| | - Jeffrey A Cadeddu
- Department of Urology, University of Texas Southwestern Medical Center , Dallas, Texas
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Ramirez D, Zargar H, Caputo P, Kaouk JH. Robotic-assisted laparoscopic prostatectomy: An update on functional and oncologic outcomes, techniques, and advancements in technology. J Surg Oncol 2015; 112:746-52. [PMID: 26369794 DOI: 10.1002/jso.24040] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Accepted: 08/26/2015] [Indexed: 11/11/2022]
Abstract
The robotic platform has revolutionized the management of prostate cancer over the last 15 years. Several techniques have been developed to improve functional and oncologic outcomes, including meticulous apical and posterior dissection, nerve sparing techniques, bladder neck and urethral length sparing, and anastomotic reconstruction. Future developments involving novel single-site, robotic technology will undoubtedly further the field of minimally invasive urology. These topics are reviewed within this article.
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Affiliation(s)
- Daniel Ramirez
- Glickman Institute of Urology and Nephrology, Cleveland Clinic, Cleveland, Ohio
| | - Homayoun Zargar
- Glickman Institute of Urology and Nephrology, Cleveland Clinic, Cleveland, Ohio
| | - Peter Caputo
- Glickman Institute of Urology and Nephrology, Cleveland Clinic, Cleveland, Ohio
| | - Jihad H Kaouk
- Glickman Institute of Urology and Nephrology, Cleveland Clinic, Cleveland, Ohio
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Transurethral versus suprapubic catheter at robot-assisted radical prostatectomy: a prospective randomized trial with 1-year follow-up. World J Urol 2015; 34:407-11. [DOI: 10.1007/s00345-015-1678-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 08/25/2015] [Indexed: 10/23/2022] Open
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Editorial Comment. Urology 2015; 86:406. [PMID: 26189331 DOI: 10.1016/j.urology.2015.02.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Agarwal G, Valderrama O, Luchey AM, Pow-Sang JM. Robotic-Assisted Laparoscopic Radical Prostatectomy. Cancer Control 2015; 22:283-90. [DOI: 10.1177/107327481502200305] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Gautum Agarwal
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Oscar Valderrama
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Adam M. Luchey
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Julio M. Pow-Sang
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
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26
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Abdollah F, Menon M. Percutaneous suprapubic tube after robotic assisted radical prostatectomy: true or placebo benefit? Eur Urol 2014; 66:613-4. [PMID: 24630418 DOI: 10.1016/j.eururo.2014.02.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 02/21/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Firas Abdollah
- Vattikuti Urology Institute and VUI Center for Outcomes Research and Evaluation, Henry Ford Hospital, Detroit, MI, USA.
| | - Mani Menon
- Vattikuti Urology Institute and VUI Center for Outcomes Research and Evaluation, Henry Ford Hospital, Detroit, MI, USA
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