URETHRAL CATHETER REMOVAL 7 OR 14 DAYS AFTER RADICAL RETROPUBIC PROSTATECTOMY: CLINICAL IMPLICATIONS AND COMPLICATIONS IN A RANDOMIZED STUDY
Carlos Ary Vargas Souto, Ernani Luis Rhoden, Rafael De Conti, Mário Chammas Jr., Sandro Eduardo Laste, Alexandre Fornari, Eduardo Porto Ribeiro, Liana Scholl, Claudio Telokenand José Carlos Stumpf Souto
SOUTO CAV et al. Urethral catheter removal 7 or 14 days after radical retropubic prostatectomy: clinical implications and complications in a randomized study. Rev. Hosp. Clin. Fac. Med. S.Paulo 59(5):262-265, 2004. PURPOSE: To evaluate the hypothesis that a 7-day period of indwelling catheter after radical retropubic prostatectomy is effective and safe without theneed of performing cystography. METHODS: In the period from January of 2000 to July of 2002, 73 patients underwent radical retropubic prostatectomy, and these patients were prospectively randomized in 2 groups: Group 1–37 patients who had the urethral catheter removed 7 days after the procedure, and Group 2–36 patients who had the catheter removed 14 days after the surgery. The 2 groups weresimilar, the surgeons and the technique were the same, and no cystography was performed to evaluate the presence of leaks. RESULTS: Two patients in Group 1 had bleeding and clot retention after having the catheter taken out in the seventh postoperative day and were managed by putting the catheter back in for 7 more days. Two patients in Group 2 developed bladder neck stricture and were treated bybladder neck incision with success. The continence rate was the same, with 2 cases of incontinence in each group. About 2 pads a day were used by the patients with incontinence. The average follow-up was 17.5 months (12-36 months). No urinary fistula, urinoma, or pelvic abscesses developed after catheter removal. Two patients were excluded from the analysis of this series: 1 died with a pulmonaryembolus in the third postoperative day, and 1 developed a urinary suprapubic fistula before catheter withdrawal, which was maintained for 16 days. CONCLUSION: Withdrawal of the urethral catheter 7 days after radical retropubic prostatectomy, without performing cystography, has a low rate of short-term complications that are equivalent to withdrawal 14 days after the surgery. KEY WORDS: Prostate cancer.Radical prostatectomy. Urethral catheterization. Prostate. Catheter withdrawal.
Radical prostatectomy is a standard procedure for the treatment of localized prostate cancer in patients in good health who are under 70 years of age.1 Until 1982, when Walsh et al.2 introduced a refined technique for performing radical retropubic prostatectomy (RRP), this procedure was not widely used because ofthe high rates of associated morbidity and mortality. Standard reconstructive technique after RRP involves the placement of a
urethral catheter for stenting the vesicourethral anastomosis and bladder drainage.3 There is some debate in the literature about how many days the urethral catheter should be left in afFrom the Division of Urology of the Santa Casa of Porto Alegre (ISCMPA) and FederalFoundation of Porto Alegre (FFFCMA) Porto Alegre/Rio Grande do Sul, Brazil. Email: firstname.lastname@example.org Received for publication on February 27, 2004
ter RRP. In the early description of this procedure, 21 to 30 days was the period normally advocated. Subsequent studies3-5 showed that 14 days was safe for this purpose. More recently, it has been reported that it is safe to remove catheters in mostpatients 3 to 4 days after RRP if a cystogram demonstrates no extravasation.6 Nadu et al.7 demonstrated that in 2 to 4 days after laparoscopic RRP, an absence of contrast leakage was ob-
REV. HOSP. CLÍN. FAC. MED. S. PAULO 59(5):262-265, 2004
Urethral catheter removal 7 or 14 days after radical retropubic Souto CAV et al.
served in 84.9% of the patients, and that urethral...