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).
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.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin. 2019;69(1):7–34.
Navaratnam A, Abdul-Muhsin H, Humphreys M. Updates in Urologic Robot Assisted Surgery. F1000Res. 2018;7:F1000.
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.
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.
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.
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.
•• 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.
•• 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.
•• 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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Sun Y, et al. Suprapubic catheter: the replacement of conventional urethral catheter after robot-assisted laparoscopic prostatectomy. J Modern Urol. 2018;8:600–4.
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.
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.
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.
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.
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.
Lee DJ, Ding J, Guzzo TJ. Improving operating room efficiency. Curr Urol Rep. 2019;20(6):28.
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.
Riemann BL, Lininger M. Statistical primer for athletic trainers: the difference between statistical and clinical meaningfulness. J Athl Train. 2015;50(12):1223–5.
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.
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.
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.
Prasad SM, Smith ND, Catalona WJ, Sammon J, Menon M. Suprapubic tube after radical prostatectomy. J Urol. 2013;189(6):2028–30.
Conflict of Interest
No potential conflicts of interest from any authors.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This article is part of the Topical Collection on Endourology
About this article
Cite this article
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). https://doi.org/10.1007/s11934-020-00982-3
- Prostate cancer
- Urethral catheter
- Suprapubic tube