The risk of urinary retention following robot-assisted radical prostatectomy and its impact on early continence outcomes

Abstract

Introduction: We aimed to evaluate the risk factors of acute urinary retention (AUR) following robot-assisted radical prostatectomy (RARP), as well as the relationship of AUR with early continence outcomes. Methods: The records of 740 consecutive patients who underwent RARP by two experienced surgeons at our institution were retrospectively reviewed from a prospectively collected database. Multiple factors, including age, body mass index (BMI), international prostate symptom score (IPSS), prostate volume, presence of median lobe, nerve preservation status, anastomosis time, and catheter removal time (Day 4 vs. 7), were evaluated as risk factors for AUR using univariate and multivariate analysis. The relation between AUR and early return of continence (one and three months) post-RARP was also evaluated. Results: The incidence of clinically significant vesico-urethral anastomotic (VUA) leak and AUR following catheter removal were 0.9% and 2.2% (17/740), respectively. In men who developed AUR, there was no significant relationship with regards to age, BMI, IPSS, prostatic volume, median lobe, nerve preservation, or anastomosis time; however, the incidence of AUR was significantly higher for men with catheter removal at Day 4 (4.5% [16/351]) vs. Day 7 (0.2% [1/389]) (p=0.004). Moreover, patients with early removal of the catheter (Day 4) who developed AUR had an earlier one-month return of 0-pad continence 87.5% (14/16) compared to patients without AUR 45.6% (153/335), with no significant difference at three months. Conclusions: While AUR is an uncommon complication of RARP, its incidence is much higher than VUA leakage. Further, it is often not well-discussed during patient counselling preoperatively. Moreover, earlier return of urinary continence was observed in patients experiencing AUR following RARP exclusively with catheter removal at Day 4. Future studies are warranted to validate the long-term impact of AUR on continence outcomes.

Ideal timing of indwelling catheter removal after robot-assisted radical prostatectomy with a running barbed suture technique: a prospective analysis of 425 consecutive patients

“…Despite its larger costs, RARP has largely replaced the open approach, where available [10,11]. Improved visualization of the bladder neck and urethra during RARP led to decreased rates of VUA leakage as well as decreased rates of AUR, independent of time of catheter removal, compared to open surgery techniques [1,2,[12][13][14][15]. The major finding of our prospective study was that early catheter removal after RARP is feasible yet associated with a higher AUR rate.…”

“…Despite a considerable retention rate of 6.3% in our series, all patients were able to void spontaneously immediately after catheter removal. Some authors propose that AUR is due to edema of the VUA, an increased bladder neck muscle tone or postoperative pain [1,2,19,20]. Patel et al showed reduced AUR rates with Tamsulosin but the effect is likely to be dependent on the grade of bladder neck sparing [20].…”

“…Despite its larger costs, RARP has largely replaced the open approach, where available [ 10 , 11 ]. Improved visualization of the bladder neck and urethra during RARP led to decreased rates of VUA leakage as well as decreased rates of AUR, independent of time of catheter removal, compared to open surgery techniques [ 1 , 2 , 12 – 15 ].…”

“…Only a few studies analyzed the issue of timing of catheter removal in more detail with heterogeneous study designs, all showing that early removal is feasible, yet prone to a higher complication rate. Early catheter removal may result in a higher rate of re-catheterization due to acute urinary retention (AUR), secondary urinary leakage or anastomotic disruption [ 1 , 2 ]. A prolonged catheterization time, however, leads to patient discomfort and implicates the risk of catheter dependent complications, such as urinary tract infections, and negatively impacts on short- and intermediate urinary continence rates [ 3 – 6 ].…”

Incidence and impact of acute urinary retention after robot-assisted radical prostatectomy

“…However, other mechanisms such as increased bladder neck smooth muscle tone or pressure by surrounding hematoma have also been implicated in AUR after RARP. [ 5 , 8 , 9 ].…”