Early Removal of the Catheter After Laparoscopic Radical Prostatectomy

Nadu, Andrei; Salomon, Laurent; Hoznek, A.; Olsson, Leif Eric; Saint, F.; Taille, Alexandre de la; Cicco, Antony; Chopin, Dominique; ABBOU, CL??MENT-CLAUDE

doi:10.1097/00005392-200111000-00011

Cited by 15 publications

(18 citation statements)

References 8 publications

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“…First, urinary extravasation seems to have no deleterious effect, as was thought previously, when extravasation was considered to increase the chances of urinary incontinence or BN sclerosis after RP. This concept arose from studies showing that ≈ 15% of patients who had RP had urinary extravasation at ≈ 4 days after surgery, and of these ≈ 11% developed BN sclerosis [17,18]. However, the present results are corroborated by Schatzl et al [14], who showed that urinary extravasation does not compromise the rate of urinary continence.…”

Section: Discussionsupporting

confidence: 73%

The influence of bladder neck mucosal eversion and early urinary extravasation on patient outcome after radical retropubic prostatectomy: a prospective controlled trial

et al. 2005

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sclerosis and the rate of urinary incontinence (more than one pad/day) was assessed by double-blind interviews at 2 days, 2 months and 6 months after catheter removal, and the incidence of BN sclerosis was also assessed after 12 months. RESULTSIn the groups with or with no BN mucosal eversion, 48 and 47 patients, respectively, fulfilled the selection criteria. Urinary leakage after vesico-urethral anastomosis was more common after mucosal eversion (33% vs 21%), but not significantly ( P = 0.251). BN sclerosis occurred in only one patient, with no mucosal eversion. The rate of urinary continence was similar in both groups at 2 days (69% vs 68%, respectively), 2 months (90% vs 87%) and 6 months (92% vs 92%) after surgery. Urinary extravasation at 4 days after surgery was followed by same rate of BN sclerosis and urinary continence as in patients with no urinary extravasation. CONCLUSIONBN mucosal eversion before vesico-urethral anastomosis during RRP is not essential to reduce the frequency of BN sclerosis or urinary incontinence. Early radiological urinary extravasation at the vesico-urethral anastomosis did not increase the risk of BN sclerosis or urinary incontinence. KEYWORDSprostatectomy, surgical technique, urinary incontinence, bladder neck obstruction, stenosis.

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Section: Discussionsupporting

confidence: 73%

The influence of bladder neck mucosal eversion and early urinary extravasation on patient outcome after radical retropubic prostatectomy: a prospective controlled trial

et al. 2005

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“…Laparoscopic surgeons advocate that one of the advantages of laparoscopic RRP is early catheter removal, because they can create a completely watertight running anastomosis under the magnification of the laparoscopic lens. However, acute urinary retention [19] also occurred in 10.4% of patients. The earlier the catheter is removed the less time is provided for the oedema to subside.…”

Section: Discussionmentioning

confidence: 98%

Evaluation of urinary extravasation and results after continence‐preserving radical retropubic prostatectomy

Varkarakis¹,

Wirtenberger²,

Pinggera³

et al. 2004

BJU International

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OBJECTIVETo evaluate the feasibility of urinary catheter removal 10 days after a radical retropubic prostatectomy (RRP) by assessing the incidence of urinary extravasation and its effect on postoperative stricture and continence rates. PATIENTS AND METHODSDuring a 4.5-year period, 619 patients undergoing RRP were evaluated. If no extravasation was detected on gravity cystography, the urinary catheter was removed 10 days after RRP. In patients with significant extravasation the catheter was left in place for 3 weeks. Overall stricture and continence rates were recorded in patients at 3, 6 and 12 months after surgery. RESULTSThere was extravasation during cystography in 29 patients (4.6%). At 3, 6 and 12 months, continence rates after catheter removal at 10 days were 74.9%, 87.9%, and 93.6%, respectively, while in the late-removal group they were 72.4%, 84.6% and 90.9%, respectively, with no significant difference between the groups. At 3 months the overall continence rate was 74.8% and at 12 months up to 93.5%. There was no difference in stricture rates between the groups, with an overall stricture rate of 0.7%. CONCLUSIONSCatheter removal 10 days after RRP is feasible, giving excellent early and late continence rates, with low anastomotic stricture rates obtained using good surgical technique. Extravasation at 10 days was rare and with proper management did not influence the final results.

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“…Proponents of laparoscopic RP cite the shorter duration of catheterization as one of the advantages resulting from better visualization of the anastomosis and more precise suturing. Nadu et al [7] reported a leak rate of 15.1% and advocated the use of cystography in the decision to remove the catheter. All of these leaks were minimal.…”

Section: Discussionmentioning

confidence: 99%

Can leakage at the vesico‐urethral anastomosis be predicted after radical retropubic prostatectomy?

Ramsden¹,

Chodak²

2004

BJU International

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assess vesico-urethral integrity before catheter removal. RESULTSOf the 275 patients, 75% and 89% had cystography before 8 and 10 days after RRP, respectively; 71% of patients had no leak on cystography and were catheter-free at 8 days. Eighty-four leaks were identified, of which 25 (9.6%) were moderate or large. Previous transurethral prostatectomy, ischaemic heart disease, blood loss, mucosal eversion and preservation of the prostatic urethra were significant risk factors for developing a leak and were used to create a nomogram to assess the relative risk of leakage. However, none of the variables assessed, either alone or combined, could be used to predict which leaks were clinically significant. CONCLUSIONSLeakage cannot be reliably predicted at the vesico-urethral anastomosis. Cystograms are necessary to identify clinically significant leaks at 8 days and should be taken if early catheter removal is being considered.

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Early Removal of the Catheter After Laparoscopic Radical Prostatectomy

Abstract: Patients who undergo laparoscopic radical prostatectomy can have the catheter safely removed 2 to 4 days postoperatively without a higher risk of incontinence, stricture or leak related problems.

Cited by 15 publications

References 8 publications

The influence of bladder neck mucosal eversion and early urinary extravasation on patient outcome after radical retropubic prostatectomy: a prospective controlled trial

The influence of bladder neck mucosal eversion and early urinary extravasation on patient outcome after radical retropubic prostatectomy: a prospective controlled trial

Evaluation of urinary extravasation and results after continence‐preserving radical retropubic prostatectomy

Can leakage at the vesico‐urethral anastomosis be predicted after radical retropubic prostatectomy?

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