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

Robot-assisted radical prostatectomy (RARP) has largely replaced open radical prostatectomy as the standard surgical treatment for prostate cancer. However, postoperative urinary incontinence still persists and has a significant impact on quality of life. We report the superior results of the detrusorrhaphy technique during RARP that helps achieve early continence. Our prospective study involved 95 consecutive patients who underwent RARP between March 2015 and May 2017; fifty patients underwent RARP using the new detrusorrhaphy technique (group 1) and 45 underwent standard RARP (group 2). The postoperative oncological and functional outcomes were compared between the two groups. The postoperative continence was assessed at 0 day, 1 week, 4 weeks, 8–12 weeks, and 6 months after catheter removal. Continence was defined as the use of no pad over a 24 h period. Mean operative time in groups 1 and 2 were 250 and 220 min, respectively. Intraoperative complications were not encountered in any patient. The continence rates after catheter removal in groups 1 and 2 were 68% and 0% at 0 day, 78% and 17.8% at 1 week, 86% and 64.4% at 4 weeks, 92% and 73.3% at 8–12 weeks, and 100% and 91.1% at 6 months, respectively. In the multivariate analysis, the nerve sparing technique, D’Amico risk groups, and prostate volume were involved in the early recovery of urinary continence. The detrusorrhaphy technique is simple, safe, and feasible, which helped achieve earlier continence. It showed significantly better outcomes than those achieved with the standard RARP technique in terms of urinary incontinence. Nevertheless, our findings need to be validated in further studies.

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Daily urine loss immediately after urethral catheter removal may be an effective predictor of long‐term urinary incontinence following robot‐assisted laparoscopic radical prostatectomy

International Journal of Clinical Practice ◽

10.1111/ijcp.13736 ◽

2020 ◽

Author(s):

Yoshihisa Matsukawa ◽

Yasushi Yoshino ◽

Takashi Fujita ◽

Yasuhito Funahashi ◽

Tsuyoshi Majima ◽

...

Keyword(s):

Urinary Incontinence ◽

Radical Prostatectomy ◽

Urethral Catheter ◽

Laparoscopic Radical Prostatectomy ◽

Catheter Removal ◽

Robot Assisted ◽

Daily Urine ◽

Urine Loss

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Early versus standard catheter removal after complete anatomical reconstruction during robot-assisted radical prostatectomy: Results from a prospective single-institutional randomized trial (RIPRECA)

European Urology Supplements ◽

10.1016/s1569-9056(18)32312-1 ◽

2018 ◽

Vol 17 (2) ◽

pp. e1905

Author(s):

G. Lista ◽

G. Lughezzani ◽

N. Buffi ◽

R. Peschechera ◽

M. Lazzeri ◽

...

Keyword(s):

Radical Prostatectomy ◽

Randomized Trial ◽

Catheter Removal ◽

Anatomical Reconstruction ◽

Robot Assisted

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Re: Retzius-Sparing Robot-Assisted Radical Prostatectomy Using the Revo-i Robotic Surgical System: Surgical Technique and Results of the First Human Trial

The Journal of Urology ◽

10.1097/ju.0000000000000081 ◽

2019 ◽

Vol 201 (4) ◽

pp. 647-648

Author(s):

Jeffrey A. Cadeddu

Keyword(s):

Radical Prostatectomy ◽

Surgical Technique ◽

Robot Assisted ◽

Human Trial ◽

Robotic Surgical System ◽

Surgical System

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The risk of urinary retention following robot-assisted radical prostatectomy and its impact on early continence outcomes

Canadian Urological Association Journal ◽

10.5489/cuaj.4649 ◽

2017 ◽

Vol 12 (3) ◽

pp. E121-5 ◽

Cited By ~ 2

Author(s):

Mansour Alnazari ◽

Marc Zanaty ◽

Khaled Ajib ◽

Assaad El-Hakim ◽

Kevin C. Zorn

Keyword(s):

Risk Factors ◽

Radical Prostatectomy ◽

Urinary Retention ◽

Catheter Removal ◽

Urinary Continence ◽

Median Lobe ◽

Robot Assisted ◽

Patient Counselling ◽

Nerve Preservation ◽

Significant Difference

Introduction: We aimed to evaluate the risk factors of acute urinary retention (AUR) following robot-assisted radical prostatectomy (RARP), as well as the relationship of AUR with early continence outcomes.Methods: The records of 740 consecutive patients who underwent RARP by two experienced surgeons at our institution were retrospectively reviewed from a prospectively collected database. Multiple factors, including age, body mass index (BMI), international prostate symptom score (IPSS), prostate volume, presence of median lobe, nerve preservation status, anastomosis time, and catheter removal time (Day 4 vs. 7), were evaluated as risk factors for AUR using univariate and multivariate analysis. The relation between AUR and early return of continence (one and three months) post-RARP was also evaluated.Results: The incidence of clinically significant vesico-urethral anastomotic (VUA) leak and AUR following catheter removal were 0.9% and 2.2% (17/740), respectively. In men who developed AUR, there was no significant relationship with regards to age, BMI, IPSS, prostatic volume, median lobe, nerve preservation, or anastomosis time; however, the incidence of AUR was significantly higher for men with catheter removal at Day 4 (4.5% [16/351]) vs. Day 7 (0.2% [1/389]) (p=0.004). Moreover, patients with early removal of the catheter (Day 4) who developed AUR had an earlier one-month return of 0-pad continence 87.5% (14/16) compared to patients without AUR 45.6% (153/335), with no significant difference at three months.Conclusions: While AUR is an uncommon complication of RARP, its incidence is much higher than VUA leakage. Further, it is often not well-discussed during patient counselling preoperatively. Moreover, earlier return of urinary continence was observed in patients experiencing AUR following RARP exclusively with catheter removal at Day 4. Future studies are warranted to validate the long-term impact of AUR on continence outcomes.

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