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World Journal of Urology

, Volume 36, Issue 9, pp 1365–1372 | Cite as

Supra-pubic versus urethral catheter after robot-assisted radical prostatectomy: systematic review of current evidence

  • Riccardo Bertolo
  • Andrew Tracey
  • Prokar Dasgupta
  • Bernardo Rocco
  • Salvatore Micali
  • Giampaolo Bianchi
  • Lance Hampton
  • Ash K. Tewari
  • Francesco Porpiglia
  • Riccardo Autorino
Review

Abstract

Purpose

To provide latest evidence on the use of suprapubic catheter (SPC) versus urethral catheter (UC) after robot-assisted laparoscopic radical prostatectomy (RARP).

Materials and methods

A systematic revision of literature was performed up to September 2017 using different search engines (Pubmed, Ovid, Scopus) to identified studies comparing the use of SPC versus standard UC after RARP. Identification and selection of the studies were conducted according to the preferred reporting items for systematic reviews and meta-analysis criteria. For continuous outcomes, the weighted mean difference (WMD) was used as a summary measure, whereas the odds ratio (OR) or risk ratio (RR) with 95% confidence interval (CI) was calculated for binary variables. RR was preferred in cases of a high number of events to avoid overestimation. Pooled estimates were calculated using the random-effect model to account for clinical heterogeneity. All statistical analyses were performed using Review manager 5 (Cochrane Collaboration, Oxford, UK).

Results

Eight studies were identified and included in this systematic review, namely 3 RCTs, 4 non-randomized prospective studies, and one retrospective study. A total of 966 RARP cases were collected for the cumulative analysis. Among them, 492 patients received standard UC and 474 SPC placement after RARP. UC patients had higher baseline PSA (WMD 0.44 ng/ml; p = 0.02). Visual Analog Scale (VAS) score was found to be significantly lower in patients with SPC at postoperative day 7 (WMD 0.53; 95% CI 0.13–0.93; p = 0.009). Regarding penile pain, a significant difference in favor of the SPC group was found at postoperative day 7 assessment (WMD 1.2; 95% CI 0.82–1.6; p < 0.001). More patients in the SPC group reported “not at all” or “minimal pain” at this time point (OR 0.17, 95% CI 0.06, 0.44; p < 0.001). No significant differences were found in terms of continence recovery rate at 6–12 weeks between the groups (UC 78.7%, 88.2%; RR 0.92, 95% CI 0.84, 1.01; p = 0.09). Similarly, no differences were found in terms of catheter-related issues (p = 0.17). However, UC patients had lower likelihood of overall complications (OR 0.44, 95% CI 0.21–0.89, p = 0.02).

Conclusions

Available evidence suggests that the use of SPC can be a viable option for postoperative urine drainage after RARP, as it can translate into decreased postoperative pain without carrying a significant higher risk of catheter-related complications. Further investigation seems to be warranted, ideally within the framework of a multicentre randomized study with standardized analysis of outcomes.

Keywords

Prostate cancer Suprapubic catheter Robot-assisted radical prostatectomy Urethral catheter 

Notes

Author contributions

R. Bertolo have contributed in manuscript writing; A. Tracey have contributed in data collection or management, data analysis; P. Dasgupta, B. Rocco S. Micali, G. Bianchi, and L. Hampton have contributed in manuscript editing, A.K. Tewari have contributed in protocol/project development, manuscript editing; F. Porpiglia and R. Autorino have contributed in protocol/project development, manuscript editing.

Compliance with ethical standards

Conflicts of interest

All authors declare that they have no conflict of interest.

References

  1. 1.
    Mistretta FA, Grasso AA, Buffi N et al (2015) Robot-assisted radical prostatectomy: recent advances. Minerva Urol Nefrol 67(3):281–292PubMedGoogle Scholar
  2. 2.
    Leow JJ, Chang SL, Meyer CP et al (2016) Robot-assisted versus open radical prostatectomy: a contemporary analysis of an all-payer discharge database. Eur Urol 70(5):837–845CrossRefPubMedGoogle Scholar
  3. 3.
    Ilic D, Evans SM, Allan CA, Jung JH, Murphy D, Frydenberg M (2017) Laparoscopic and robot-assisted vs open radical prostatectomy for the treatment of localized prostate cancer: a Cochrane systematic review. BJU Int.  https://doi.org/10.1111/bju.14062 PubMedGoogle Scholar
  4. 4.
    Huang X, Wang L, Zheng X, Wang X (2017) Comparison of perioperative, functional, and oncologic outcomes between standard laparoscopic and robotic-assisted radical prostatectomy: a systemic review and meta-analysis. Surg Endosc 31(3):1045–1060CrossRefPubMedGoogle Scholar
  5. 5.
    Porpiglia F, Fiori C, Bertolo R et al (2016) Five-year outcomes for a prospective randomised controlled trial comparing laparoscopic and robot-assisted radical prostatectomy. Eur Urol Focus.  https://doi.org/10.1016/j.euf.2016.11.007 Google Scholar
  6. 6.
    Heesakkers J, Farag F, Bauer RM, Sandhu J, De Ridder D, Stenzl A (2017) Pathophysiology and contributing factors in postprostatectomy incontinence: a review. Eur Urol 71(6):936–944CrossRefPubMedGoogle Scholar
  7. 7.
    Kojima Y, Takahashi N, Haga N et al (2013) Urinary incontinence after robot-assisted radical prostatectomy: pathophysiology and intraoperative techniques to improve surgical outcome. Int J Urol 20(11):1052–1063CrossRefPubMedGoogle Scholar
  8. 8.
    Pavlovich CP, Rocco B, Druskin SC, Davis JW (2017) Urinary continence recovery after radical prostatectomy—anatomical/reconstructive and nerve-sparing techniques to improve outcomes. BJU Int 120(2):185–196CrossRefPubMedGoogle Scholar
  9. 9.
    Porpiglia F, Bertolo R, Manfredi M et al (2016) Total anatomical reconstruction during robot-assisted radical prostatectomy: implications on early recovery of urinary continence. Eur Urol 69(3):485–495CrossRefPubMedGoogle Scholar
  10. 10.
    Gratzke C, Dovey Z, Novara G et al (2016) Early catheter removal after robot-assisted radical prostatectomy: surgical technique and outcomes for the Aalst technique (ECaRemA study). Eur Urol 69(5):917–923CrossRefPubMedGoogle Scholar
  11. 11.
    Tewari A, Rao S, Mandhani A (2008) Catheter-less robotic radical prostatectomy using a custom-made synchronous anastomotic splint and vesical urinary diversion device: report of the initial series and perioperative outcomes. BJU Int 102(8):1000–1004CrossRefPubMedGoogle Scholar
  12. 12.
    Haute WV, Dasgupta P (2010) Urethral catheter-less robotic-assisted radical prostatectomy. BJU Int 105(9):1201–1203CrossRefPubMedGoogle Scholar
  13. 13.
    Martinschek A, Pfalzgraf D, Rafail B, Ritter M, Heinrich E, Trojan L (2016) Transurethral versus suprapubic catheter at robot-assisted radical prostatectomy: a prospective randomized trial with 1-year follow-up. World J Urol 34(3):407–411CrossRefPubMedGoogle Scholar
  14. 14.
    Harke N, Godes M, Habibzada J et al (2017) Postoperative patient comfort in suprapubic drainage versus transurethral catheterization following robot-assisted radical prostatectomy: a prospective randomized clinical trial. World J Urol 35(3):389–394CrossRefPubMedGoogle Scholar
  15. 15.
    Prasad SM, Large MC, Patel AR et al (2014) Early removal of urethral catheter with suprapubic tube drainage versus urethral catheter drainage alone after robot-assisted laparoscopic radical prostatectomy. J Urol 192(1):89–95CrossRefPubMedGoogle Scholar
  16. 16.
    Krane LS, Bhandari M, Peabody JO, Menon M (2009) Impact of percutaneous suprapubic tube drainage on patient discomfort after radical prostatectomy. Eur Urol 56:325–331CrossRefPubMedGoogle Scholar
  17. 17.
    Morgan MS, Ozayar A, Friedlander JI et al (2016) An assessment of patient comfort and morbidity after robot-assisted radical prostatectomy with suprapubic tube versus urethral catheter drainage. J Endourol 30(3):300–305CrossRefPubMedGoogle Scholar
  18. 18.
    Yang CJ, Ou YC, Yang CK (2015) Percutaneous cystostomy drainage for early removing urethral catheter in robotic-assisted laparoscopic radical prostatectomy: improving on patients’ discomfort. Urol Sci 26:240–242CrossRefGoogle Scholar
  19. 19.
    Afzal MZ, Tobert CM, Bulica E, Noyes SL, Lane BR (2015) Modification of technique for suprapubic catheter placement after robot-assisted radical prostatectomy reduces catheter-associated complications. Urology 86(2):401–406CrossRefPubMedGoogle Scholar
  20. 20.
    Wells GA, Shea B, O’Connell D, et al. The Newcastle Ottawa 1 Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp
  21. 21.
    Clark HD, Wells GA, Huët C, McAlister FA, Salmi LR, Fergusson D, Laupacis A (1999) Assessing the quality of randomized trials: reliability of the Jadad scale. Control Clin Trials 20(5):448–452CrossRefPubMedGoogle Scholar
  22. 22.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5:13CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Tan GW, Chan SP, Ho CK (2010) Is transurethral catheterisation the ideal method of bladder drainage? A survey of patient satisfaction with indwelling transurethral urinary catheters. Asian J Surg 33(1):31–36CrossRefPubMedGoogle Scholar
  25. 25.
    Schiffmann J, Haese A, Boehm K et al (2017) Ten-year experience of robot-assisted radical prostatectomy: the road from cherry-picking to standard procedure. Minerva Urol Nefrol 69(1):69–75PubMedGoogle Scholar
  26. 26.
    Albani JM, Zippe CD (2002) Urethral catheter removal 3 days after radical retropubic prostatectomy is feasible and desirable. Prostate Cancer Prostatic Dis 5(4):291–295CrossRefPubMedGoogle Scholar
  27. 27.
    Lepor H, Nieder AM, Fraiman MC (2001) Early removal of urinary catheter after radical retropubic prostatectomy is both feasible and desirable. Urology 58(3):425–429CrossRefPubMedGoogle Scholar
  28. 28.
    Brassetti A, Emiliozzi P, Cardi A et al (2017) Removing transurethral catheter on postoperative day 2 after Robot-assisted laparoscopic radical prostatectomy: towards a new standard? Minerva Urol Nefrol.  https://doi.org/10.23736/s0393-2249.17.02917-4 Google Scholar
  29. 29.
    Healy EF, Walsh CA, Cotter AM, Walsh SR (2012) Suprapubic compared with transurethral bladder catheterization for gynecologic surgery: a systematic review and meta-analysis. Obstet Gynecol 120(3):678–687.  https://doi.org/10.1097/AOG.0b013e3182657f0d CrossRefPubMedGoogle Scholar
  30. 30.
    Niel-Weise BS, van den Broek PJ (2005) Urinary catheter policies for short-term bladder drainage in adults. Cochrane Database Syst Rev.  https://doi.org/10.1002/14651858.cd004203.pub2 Google Scholar
  31. 31.
    Ficarra V, Wiklund PN, Rochat CH et al (2013) The European Association of Urology Robotic Urology Section (ERUS) survey of robot-assisted radical prostatectomy (RARP). BJU Int 111:596CrossRefPubMedGoogle Scholar
  32. 32.
    Dahm P, Jung JH, Morgan RL (2018) The challenge with systematic reviews of non-randomised studies in urology. BJU Int 121(2):161–162.  https://doi.org/10.1111/bju.14105 CrossRefPubMedGoogle Scholar

Copyright information

© This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2018

Authors and Affiliations

  • Riccardo Bertolo
    • 1
  • Andrew Tracey
    • 2
  • Prokar Dasgupta
    • 3
  • Bernardo Rocco
    • 4
  • Salvatore Micali
    • 4
  • Giampaolo Bianchi
    • 4
  • Lance Hampton
    • 2
  • Ash K. Tewari
    • 5
  • Francesco Porpiglia
    • 1
  • Riccardo Autorino
    • 2
  1. 1.Department of UrologyUniversity of Turin-San Luigi Gonzaga HospitalTurinItaly
  2. 2.Division of Urology, McGuire VA Medical CenterVirginia Commonwealth UniversityRichmondUSA
  3. 3.King’s College LondonGuy’s HospitalLondonUK
  4. 4.Department of UrologyUniversity of Modena and Reggio EmiliaModenaItaly
  5. 5.Department of UrologyIcahn School of Medicine at Mount SinaiNew YorkUSA

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