Suprapubic Versus Urethral Catheter for Urinary Drainage After Robot-Assisted Radical Prostatectomy


Purpose of Review

To review the evidence regarding the usage of suprapubic tube (SPT) versus indwelling urethral catheter (IUC) after robot-assisted radical prostatectomy (RARP).

Recent Findings

Available data on the use of SPT for urinary drainage after RARP is somewhat limited mostly because of the variations of study designs and non-standardized outcomes. Although it may provide some mild benefit in terms of catheter-related pain and discomfort, the benefit seems not to be clinically significant.


The evidence in the literature so far does not support routine usage of SPT as the primary urinary drainage method after RARP. Further higher-quality studies that can show clinically significant advantages over IUC are still needed to justify its usage.

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  1. 1.

    Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin. 2019;69(1):7–34.

    Article  Google Scholar 

  2. 2.

    Navaratnam A, Abdul-Muhsin H, Humphreys M. Updates in Urologic Robot Assisted Surgery. F1000Res. 2018;7:F1000.

    PubMed  PubMed Central  Article  Google Scholar 

  3. 3.

    Gratzke C, Dovey Z, Novara G, Geurts N, de Groote R, Schatteman P, et al. Early catheter removal after robot-assisted radical prostatectomy: surgical technique and outcomes for the Aalst technique (ECaRemA study). Eur Urol. 2016;69(5):917–23.

    PubMed  Article  Google Scholar 

  4. 4.

    Lista G, et al. Early catheter removal after robot-assisted radical prostatectomy: results from a prospective single-institutional randomized trial (ripreca study). Eur Urol Focus. 2020;6(2):259–66.

  5. 5.

    Zegerman A, Ezri T, Weinbroum AA. Postoperative discomfort (other than pain) - a neglected feature of postanesthesia patient care. J Clin Monit Comput. 2008;22(4):279–84.

    PubMed  Article  Google Scholar 

  6. 6.

    Woldu SL, Weinberg AC, Bergman A, Shapiro EY, Korets R, Motamedinia P, et al. Pain and analgesic use after robot-assisted radical prostatectomy. J Endourol. 2014;28(5):544–8.

    PubMed  Article  Google Scholar 

  7. 7.

    •• Harke N, et al. Postoperative patient comfort in suprapubic drainage versus transurethral catheterization following robot-assisted radical prostatectomy: a prospective randomized clinical trial. World J Urol. 2017;35(3):389–94 RCT showing suprapubic drainage significantly decreased pain levels compared to urethral drainage without compromising long-term functional results.

    PubMed  Article  Google Scholar 

  8. 8.

    •• Martinschek A, et al. Transurethral versus suprapubic catheter at robot-assisted radical prostatectomy: a prospective randomized trial with 1-year follow-up. World J Urol. 2016;34(3):407–11 RCT showing patients with suprapubic tube were significantly less bothered by the catheter at personal and genital hygiene compared to urethral catheter.

    CAS  PubMed  Article  Google Scholar 

  9. 9.

    •• Prasad SM, et al. Early removal of urethral catheter with suprapubic tube drainage versus urethral catheter drainage alone after robot-assisted laparoscopic radical prostatectomy. J Urol. 2014;192(1):89–95 RCT showing suprapubic tube provided no benefits in terms pain, catheter related bother and treatment related satisfaction in the perioperative period compared to urethral catheter.

    PubMed  Article  Google Scholar 

  10. 10.

    Galfano A, et al. Pain and discomfort after Retzius-sparing robot-assisted radical prostatectomy: a comparative study between suprapubic cystostomy and urethral catheter as urinary drainage. Minerva Urol Nefrol. 2019;71(4):381–5.

    PubMed  Article  Google Scholar 

  11. 11.

    Morgan MS, et al. An assessment of patient comfort and morbidity after robot-assisted radical prostatectomy with suprapubic tube versus urethral catheter drainage. J Endourol. 2016;30(3):300–5.

    PubMed  Article  Google Scholar 

  12. 12.

    Yang C-J, Ou Y-C, Yang C-K. Percutaneous cystostomy drainage for early removing urethral catheter in robotic-assisted laparoscopic radical prostatectomy: improving on patients’ discomfort. Urol Sci. 2015;26(4):240–2.

    Article  Google Scholar 

  13. 13.

    Afzal MZ, Tobert CM, Bulica E, Noyes SL, Lane BR. Modification of technique for suprapubic catheter placement after robot-assisted radical prostatectomy reduces catheter-associated complications. Urology. 2015;86(2):401–6.

    PubMed  Article  Google Scholar 

  14. 14.

    Krane LS, Bhandari M, Peabody JO, Menon M. Impact of percutaneous suprapubic tube drainage on patient discomfort after radical prostatectomy. Eur Urol. 2009;56(2):325–30.

    PubMed  Article  Google Scholar 

  15. 15.

    Tewari A, Rao S, Mandhani A. 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. 2008;102(8):1000–4.

    PubMed  Article  Google Scholar 

  16. 16.

    Sammon JD, Trinh QD, Sukumar S, Diaz M, Simone A, Kaul S, et al. Long-term follow-up of patients undergoing percutaneous suprapubic tube drainage after robot-assisted radical prostatectomy (RARP). BJU Int. 2012;110(4):580–5.

    PubMed  Article  Google Scholar 

  17. 17.

    Ghani KR, Trinh QD, Sammon JD, Jeong W, Simone A, Dabaja A, et al. Percutaneous suprapubic tube bladder drainage after robot-assisted radical prostatectomy: a step-by-step guide. BJU Int. 2013;112(5):703–5.

    PubMed  Article  Google Scholar 

  18. 18.

    Sammon JD, Sharma P, Trinh QD, Ghani KR, Sukumar S, Menon M. Predictors of immediate continence following robot-assisted radical prostatectomy. J Endourol. 2013;27(4):442–6.

    PubMed  Article  Google Scholar 

  19. 19.

    Sun Y, et al. Suprapubic catheter: the replacement of conventional urethral catheter after robot-assisted laparoscopic prostatectomy. J Modern Urol. 2018;8:600–4.

    Google Scholar 

  20. 20.

    Li MX, Cheng P, Yao L, Li HJ, Xun YQ, Yan PJ, et al. Suprapubic tube compared with urethral catheter drainage after robot-assisted radical prostatectomy: a systematic review and meta-analysis. Asian J Surg. 2019;42(1):71–80.

    PubMed  Article  Google Scholar 

  21. 21.

    Jian Z, Feng S, Chen Y, Wei X, Luo D, Li H, et al. Suprapubic tube versus urethral catheter drainage after robot-assisted radical prostatectomy: a systematic review and meta-analysis. BMC Urol. 2018;18(1):1.

    PubMed  PubMed Central  Article  Google Scholar 

  22. 22.

    Hwang EC, Risk MC, Dahm P. Suprapubic versus urethral catheter drainage in robotic-assisted laparoscopic prostatectomy: advancing systematic review quality. World J Urol. 2018;36(9):1501–2.

    PubMed  Article  Google Scholar 

  23. 23.

    Bertolo R, Tracey A, Dasgupta P, Rocco B, Micali S, Bianchi G, et al. Supra-pubic versus urethral catheter after robot-assisted radical prostatectomy: systematic review of current evidence. World J Urol. 2018;36(9):1365–72.

    PubMed  Article  Google Scholar 

  24. 24.

    Fantus RJ, Cohen A, Riedinger CB, Kuchta K, Wang CH, Yao K, et al. Facility-level analysis of robot utilization across disciplines in the National Cancer Database. J Robot Surg. 2019;13(2):293–9.

    PubMed  Article  Google Scholar 

  25. 25.

    Lee DJ, Ding J, Guzzo TJ. Improving operating room efficiency. Curr Urol Rep. 2019;20(6):28.

    PubMed  Article  Google Scholar 

  26. 26.

    Kersten P, White PJ, Tennant A. Is the pain visual analogue scale linear and responsive to change? An exploration using Rasch analysis. PLoS One. 2014;9(6):e99485.

    PubMed  PubMed Central  Article  Google Scholar 

  27. 27.

    Riemann BL, Lininger M. Statistical primer for athletic trainers: the difference between statistical and clinical meaningfulness. J Athl Train. 2015;50(12):1223–5.

    PubMed  PubMed Central  Article  Google Scholar 

  28. 28.

    Webb DR, Sethi K, Gee K. An analysis of the causes of bladder neck contracture after open and robot-assisted laparoscopic radical prostatectomy. BJU Int. 2009;103(7):957–63.

    PubMed  Article  Google Scholar 

  29. 29.

    Montorsi F, Wilson TG, Rosen RC, Ahlering TE, Artibani W, Carroll PR, et al. Best practices in robot-assisted radical prostatectomy: recommendations of the Pasadena Consensus Panel. Eur Urol. 2012;62(3):368–81.

    PubMed  Article  Google Scholar 

  30. 30.

    Breyer BN, Davis CB, Cowan JE, Kane CJ, Carroll PR. Incidence of bladder neck contracture after robot-assisted laparoscopic and open radical prostatectomy. BJU Int. 2010;106(11):1734–8.

    PubMed  PubMed Central  Article  Google Scholar 

  31. 31.

    Prasad SM, Smith ND, Catalona WJ, Sammon J, Menon M. Suprapubic tube after radical prostatectomy. J Urol. 2013;189(6):2028–30.

    PubMed  Article  Google Scholar 

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Correspondence to Leilei Xia.

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Xia, L., Guzzo, T.J., Mucksavage, P. et al. Suprapubic Versus Urethral Catheter for Urinary Drainage After Robot-Assisted Radical Prostatectomy. Curr Urol Rep 21, 30 (2020).

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  • Prostate cancer
  • Robotics
  • Prostatectomy
  • Urethral catheter
  • Suprapubic tube