Outcomes and Safety of Suprapubic vs Urethral Catheterization Following Pelvic Fascia Sparing Robotic Prostatectomy

by Selleckchem | Jan 10 2024

Introduction: Urethral catheter (UC) discomfort remains a burden following robotic-assisted radical prostatectomy (RARP). Suprapubic catheters (SPC) may reduce patient discomfort and increase satisfaction. Pelvic Fascia Sparing RARP (PFS-RARP) reduces the technical challenges of intra-operative SPC placement. We examined postoperative outcomes of SPC vs UC placement following PFS-RARP.

Methods: We conducted a retrospective review of a prospective IRB-approved database of PFS-RARP patients from June 2020 to December 2022 receiving SPC (n = 108) or UC (n = 104) postoperatively. Demographics, clinical, and perioperative outcomes were captured. Postoperative patient-reported quality of life was measured using Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP). Patients with intraoperative complications, intraoperative leaks, or undergoing salvage prostatectomy were excluded. Univariate and multivariate regression analyses were performed to compare outcomes.

Results: No significant differences in demographics or oncologic outcomes existed. There were no differences in complications, including urethral stricture or anastomotic leak. Men receiving SPC vs UC had earlier return to continence (7 v. 16 days, P < .001) and higher continence rates at catheter removal (67.6% v. 43.3%, P = .0003). On adjusted analyses, SPC was an independent predictor of continence at catheter removal (OR 2.21, P = .023). There were no differences between groups in preoperative or postoperative EPIC-CP scores, including no differences in postoperative quality of life (P = .46).

Conclusions: SPC after PFS-RARP is a safe and feasible alternative to UC. SPC is associated with an earlier return to continence and a greater likelihood of continence rates at catheter removal. Use of SPC may increase overall patient satisfaction following PFS-RARP.

Comments:

This study explored the effects of using suprapubic catheters (SPC) versus urethral catheters (UC) after Pelvic Fascia Sparing Robotic-Assisted Radical Prostatectomy (PFS-RARP). The goal was to determine if SPC could alleviate discomfort and enhance patient satisfaction. Here's a breakdown of the key findings:

### **Study Overview**
- **Participants**: 212 patients undergoing PFS-RARP (SPC: 108, UC: 104)
- **Data Collection**: Retrospective review of a prospective database (June 2020 to December 2022)
- **Exclusions**: Patients with intraoperative complications, leaks, or undergoing salvage prostatectomy
- **Measures**: Demographics, perioperative outcomes, complications, and patient-reported quality of life using EPIC-CP

### **Results**
- **Demographics and Oncologic Outcomes**: No significant differences between SPC and UC groups.
- **Complications**: No differences in urethral stricture or anastomotic leak rates.
- **Continence**: SPC users showed earlier return to continence (7 days vs. 16 days) and higher continence rates at catheter removal (67.6% vs. 43.3%).
- **Adjusted Analysis**: SPC was an independent predictor of continence at catheter removal (OR 2.21, P = .023).
- **Quality of Life**: No significant differences in preoperative or postoperative EPIC-CP scores, indicating similar quality of life between SPC and UC groups (P = .46).

### **Conclusions**
- **Safety and Feasibility**: SPC following PFS-RARP is safe and viable.
- **Continence Improvement**: SPC leads to earlier continence recovery and higher continence rates at catheter removal.
- **Patient Satisfaction**: SPC may enhance overall patient satisfaction after PFS-RARP.

This study suggests that SPC could be a favorable alternative to UC after PFS-RARP, improving continence outcomes without compromising quality of life.