Early Catheter Removal on Postoperative Day 2 After Robot-assisted Radical Prostatectomy: Updated Real-life Experience with the Aalst Technique

Develtere, Dries; Rosiello, Giuseppe; Piazza, Pietro; Bravi, Carlo Andrea; Pandey, Abhishek; Berquin, Camille; Sinatti, Céline; Puyvelde, Hannah Van; Puliatti, Stefano; Amato, Marco; Farinha, Rui; Pauwels, Evelyn; Groote, Ruben De; Schatteman, Peter; Naeyer, Geert De; D’Hondt, Frederiek; Mottrie, Alexandre

doi:10.1016/j.euf.2021.10.003

European Urology Focus

2022

DOI: 10.1016/j.euf.2021.10.003

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Early Catheter Removal on Postoperative Day 2 After Robot-assisted Radical Prostatectomy: Updated Real-life Experience with the Aalst Technique

Dries Develtere

Giuseppe Rosiello

Pietro Piazza

et al.

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Cited by 11 publications

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“…All procedures were performed with DaVinci robotic platforms using a 3-instruments configuration (scissors, fenestrated bipolar, and needle driver). As standard protocol at our Institution, urinary catheter was removed on postoperative day two [8]. Conclusions: Five different approaches for bladder neck dissection during RARP were described in this video compilation.…”

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Different approaches for bladder neck dissection during robot-assisted radical prostatectomy: the Aalst technique

et al. 2023

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Introduction: Bladder neck dissection is one of the most delicate surgical steps of robotic-assisted radical prostatectomy (RARP) [ 1 , 2 ], and it may affect surgical margins rate and functional outcomes [ 3 , 4 ]. Given the relationship between outcomes and surgical experience [ 5 – 7 ], it is crucial to implement a step-by-step approach for each surgical step of the procedure, especially in the most challenging part of the intervention. In this video compilation, we described the techniques for bladder neck dissection utilized at OLV Hospital (Aalst, Belgium). Surgical Technique: We illustrated five different techniques for bladder neck dissection during RARP. The anterior technique tackles the bladder neck from above until the urethral catheter is visualized, and then the dissection is completed posteriorly. The lateral and postero-lateral approaches involve the identification of a weakness point at the prostate-vesical junction and aim to develop the posterior plane – virtually until the seminal vesicles – prior to the opening of the urethra anteriorly. Finally, we described our techniques for bladder neck dissection in more challenging cases such as in patients with bulky middle lobes and prior surgery for benign prostatic hyperplasia. All approaches follow anatomic landmarks to minimize positive surgical margins and aim to preserve the bladder neck in order to promote optimal functional recovery. All procedures were performed with DaVinci robotic platforms using a 3-instruments configuration (scissors, fenestrated bipolar, and needle driver). As standard protocol at our Institution, urinary catheter was removed on postoperative day two [ 8 ]. Conclusions: Five different approaches for bladder neck dissection during RARP were described in this video compilation. We believe that the technical details provided here might be of help for clinicians who are starting their practice with this surgical intervention.

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Different approaches for bladder neck dissection during robot-assisted radical prostatectomy: the Aalst technique

et al. 2023

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after surgery, explaining uncomplicated courses even after removal on the 2nd day after surgery [1,2]. While early removal can avoid complications like urinary tract infections and improve quality of life, an increased risk for acute urinary retention due to tissue swelling could be observed [3,4].

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Prolonged indwelling catheter time after RARP does not lead to follow-up surgery

Lenart,

Holub,

Gutjahr

et al. 2024

World J Urol

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Background Indwelling catheterization following radical prostatectomy is used to aid healing and urinary drainage. While early removal is well investigated, prolonged catheterization has only been investigated in terms of urinary incontinence. Other complications such as anastomotic strictures are unexplored so far. This study aims to analyze the sequelae of catheterization lasting more than 14 days after robotic-assisted radical prostatectomy (RARP). Methods A prospective database of 3087 patients undergoing RARP was analyzed, focusing on 180 patients with catheterization exceeding 14 days (Group A) and 88 matched controls (Group B). Outcome measures included subsequent surgeries, complications, and functional outcomes. Results Prolonged catheterization did not significantly increase the need for subsequent surgeries (6% in Group A vs. 7% in Group B, p = .95). However, anastomotic strictures were more common in Group A (3%) compared to Group B (0%) after exclusion of risk factors. Incontinence rates were similar between groups, although a subgroup analysis revealed higher incontinence rates in patients with catheterization exceeding 28 days. No significant differences were observed in erectile function or quality of life between the groups. Conclusion Prolonged catheterization after RARP does not independently increase the risk of anastomotic strictures in the general population. However, in patients without risk factors, prolonged catheter dwell time may elevate the risk of strictures and subsequent surgeries. Additionally, patients with catheterization exceeding 28 days may experience higher rates of long-term incontinence. Further studies with larger sample sizes are needed to confirm these findings and elucidate the long-term implications of prolonged catheterization.

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A review of enhanced recovery after surgery concept in perioperative radical prostatectomy for prostate cancer

Wu,

Jiang,

Shi

et al. 2024

J Robotic Surg

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Early Catheter Removal on Postoperative Day 2 After Robot-assisted Radical Prostatectomy: Updated Real-life Experience with the Aalst Technique

Cited by 11 publications

References 13 publications

Different approaches for bladder neck dissection during robot-assisted radical prostatectomy: the Aalst technique

Different approaches for bladder neck dissection during robot-assisted radical prostatectomy: the Aalst technique

Prolonged indwelling catheter time after RARP does not lead to follow-up surgery

A review of enhanced recovery after surgery concept in perioperative radical prostatectomy for prostate cancer

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