Superior early and long-term continence following early micturition on day 2 after robot-assisted radical prostatectomy: a randomized prospective trial

Harke, Nina; Wagner, Christian von; Liakos, Nikolaos; Urbanová, Katarína; Addali, M.; Hadaschik, Boris; Witt, J.H.

doi:10.1007/s00345-020-03225-9

Cited by 5 publications

(11 citation statements)

References 33 publications

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“…Harke et al. [21] reported that no pad continence rates were 69% in patients who had their UC removed at POD5, while 80% in patients who had their UC removed at POD2. By contrast, Lista et al.…”

Section: Resultsmentioning

confidence: 99%

“…A recent RCT conducted by Harke et al. [21], assessing the long‐term impact on urinary continence rates between early (POD2 with suprapubic tube) or standard (POD5 with/without suprapubic tube) UC removal revealed that early voiding significantly improved the continence rates at 1, 6 and 12 months after RARP. Taken together, at least, early UC removal seems not to worsen the functional outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Second, most RCTs have a high risk of bias, mainly owing to their unblinded nature based on the procedural trial (i.e., the surgeon decided final eligibility for PD placement after vesicourethral anastomosis in one RCT) [25]. In addition, the two RCTs regarding early UC removal assessed the differential postoperative outcomes between UC removal at POD2-3 vs POD5 [21,24]. These slight time differences (i.e., 48 h difference) between the two groups compared to observational studies might underestimate the absolute differential complication rates.…”

Section: Discussionmentioning

confidence: 99%

“…The perioperative outcomes and demographics of included studies are shown in Table 2 [19][20][21][22][23][24] and Table S3.…”

Section: Differential Postoperative Outcomes Between Patients Who Und...mentioning

confidence: 99%

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Role of pelvic drain and timing of urethral catheter removal following RARP: a systematic review and meta‐analysis

et al. 2023

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To assess the clinical value of routine pelvic drain (PD) placement and early removal of urethral catheter (UC) in patients undergoing robot-assisted radical prostatectomy (RARP), as perioperative management such as the necessity of PD or optimal timing for UC removal remains highly variable. MethodsMultiple databases were searched for articles published before March 2022 according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement. Studies were deemed eligible if they investigated the differential rate of postoperative complications between patients with/without routine PD placement and with/without early UC removal, defined as UC removal at 2-4 days after RARP. ResultsOverall, eight studies comprising 5112 patients were eligible for the analysis of PD placement, and six studies comprising 2598 patients were eligible for the analysis of UC removal. There were no differences in the rate of any complications (pooled odds ratio [OR] 0.89, 95% confidence interval [CI] 0.78-1.00), severe complications (Clavien-Dindo Grade ≥III; pooled OR 0.95, 95% CI 0.54-1.69), all and/or symptomatic lymphocele (pooled OR 0.82, 95% CI 0.50-1.33; and pooled OR 0.58, 95% CI 0.26-1.29, respectively) between patients with or without routine PD placement. Furthermore, avoiding PD placement decreased the rate of postoperative ileus (pooled OR 0.70, 95% CI 0.51-0.91). Early removal of UC resulted in an increased likelihood of urinary retention (OR 6.21, 95% CI 3.54-10.9) in retrospective, but not in prospective studies. There were no differences in anastomosis leakage and early continence rates between patients with or those without early removal of UC. ConclusionsThere is no benefit for routine PD placement after standard RARP in the published articles. Early removal of UC seems possible with the caveat of the increased risk of urinary retention, while the effect on medium-term continence is still unclear. These data may help guide the standardisation of postoperative procedures by avoiding unnecessary interventions, thereby reducing potential complications and associated costs.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…The perioperative outcomes and demographics of included studies are shown in Table 2 [19][20][21][22][23][24] and Table S3.…”

Section: Differential Postoperative Outcomes Between Patients Who Und...mentioning

confidence: 99%

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Role of pelvic drain and timing of urethral catheter removal following RARP: a systematic review and meta‐analysis

et al. 2023

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“…This correlation can also be seen in multivariable logistic regressions for all subgroups after adjusting for further risk factors of early postoperative incontinence. A urine loss, e.g., of >50 g, resulted in a strikingly decreased chance of early urinary continence (odds ratio: 0.03) compared to patients with urine loss <1 g. The current literature is scarce about the relationship between continence status after catheter removal and early continence in RP treated patients [23,24]. For example, Manfredi et al, even though ascertaining urinary continence after RP at different time points beginning with catheter removal, solely relied on the number of pads as a proxy for urinary continence throughout their study [24].…”

Section: Discussionmentioning

confidence: 99%

Correlation of Urine Loss after Catheter Removal and Early Continence in Men Undergoing Radical Prostatectomy

et al. 2021

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Background: To determine the correlation between urine loss in PAD-test after catheter removal, and early urinary continence (UC) in RP treated patients. Methods: Urine loss was measured by using a standardized, validated PAD-test within 24 h after removal of the transurethral catheter, and was grouped as a loss of <1, 1–10, 11–50, and >50 g of urine, respectively. Early UC (median: 3 months) was defined as the usage of no or one safety-pad. Uni- and multivariable logistic regression models tested the correlation between PAD-test results and early UC. Covariates consisted of age, BMI, nerve-sparing approach, prostate volume, and extraprostatic extension of tumor. Results: From 01/2018 to 03/2021, 100 patients undergoing RP with data available for a PAD-test and early UC were retrospectively identified. Ultimately, 24%, 47%, 15%, and 14% of patients had a loss of urine <1 g, 1–10 g, 11–50 g, and >50 g in PAD-test, respectively. Additionally, 59% of patients reported to be continent. In multivariable logistic regression models, urine loss in PAD-test predicted early UC (OR: 0.21 vs. 0.09 vs. 0.03; for urine loss 1–10 g vs. 11–50 g vs. >50 g, Ref: <1 g; all p < 0.05). Conclusions: Urine loss after catheter removal strongly correlated with early continence as well as a severity in urinary incontinence.

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Vesicoprostatic muscle reconstruction: a step further for immediate and early urinary continence

Gao

Yang

et al. 2023

World J Urol

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Superior early and long-term continence following early micturition on day 2 after robot-assisted radical prostatectomy: a randomized prospective trial

Cited by 5 publications

References 33 publications

Role of pelvic drain and timing of urethral catheter removal following RARP: a systematic review and meta‐analysis

Role of pelvic drain and timing of urethral catheter removal following RARP: a systematic review and meta‐analysis

Correlation of Urine Loss after Catheter Removal and Early Continence in Men Undergoing Radical Prostatectomy

Vesicoprostatic muscle reconstruction: a step further for immediate and early urinary continence

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