Early Cystography before Catheter Removal after Robot Assisted Radical Prostatectomy: A Single Center Experience

Abstract

Purpose:Evaluate early cystography post robot-assisted radical prostatectomy (RARP) for prostate cancer (PCa), aiming to expedite discharge, compare leakage incidence, and assess associated factors. Materials and Methods: Retrospective review between January 2017 and December 2022 of 316 RARP patients at Chi Mei Medical Center. Grouped by postoperative day (POD) for cystography (≤ 3 vs. > 3 days). Assessed pre-op characteristics, hospitalization, catheter duration, leakage, and complications. Results: 142 (44.9%) underwent cystography on POD ≤ 3 and 174 (55.1%) on POD > 3. Shorter catheter indwelling (3 vs. 6 days) and hospitalization (4 vs. 7 days) in early group (p < 0.0001). Postoperative leakage rates similar (14.08% vs. 12.07%) but higher acute urine retention (9.15% vs. 3.45%, p = 0.0338) and Foley re-insertions (13.38% vs. 5.17%, p = 0.0106) in early group. Postoperative leakage associated with prolonged catheterization and hospitalization (p < 0.0001). Transurethral resection of the prostate (TURP) with bladder neck reconstruction (BNR) history and increased blood loss linked to higher leakage risk (p = 0.0309 and p = 0.0221, respectively), confirmed by both univariate and multivariate logistic regression analyses. Conclusion: Early cystography post RARP reduces hospitalization and catheter duration without increased leakage risk. Caution needed for higher acute urine retention with early catheter removal. TURP with BNR history and increased blood loss require careful monitoring for leakage. These findings guide postoperative care for RARP patients.