Urethral catheter removal 7 or 14 days after radical retropubic prostatectomy: clinical implications and complications in a randomized study

Abstract

PURPOSE:To evaluate the hypothesis that a 7-day period of indwelling catheter after radical retropubic prostatectomy is effective and safe without the need of performing cystography.METHODS: In the period from January of 2000 to July of 2002, 73 patients underwent radical retropubic prostatectomy, and these patients were prospectively randomized in 2 groups: Group 1-37 patients who had the urethral catheter removed 7 days after the procedure, and Group 2-36 patients who had the catheter removed 14 days after the surgery. The 2 groups were similar, the surgeons and the technique were the same, and no cystography was performed to evaluate the presence of leaks.RESULTS: Two patients in Group 1 had bleeding and clot retention after having the catheter taken out in the seventh postoperative day and were managed by putting the catheter back in for 7 more days. Two patients in Group 2 developed bladder neck stricture and were treated by bladder neck incision with success. The continence rate was the same, with 2 cases of incontinence in each group. About 2 pads a day were used by the patients with incontinence. The average follow-up was 17.5 months (12-36 months). No urinary fistula, urinoma, or pelvic abscesses developed after catheter removal. Two patients were excluded from the analysis of this series: 1 died with a pulmonary embolus in the third postoperative day, and 1 developed a urinary suprapubic fistula before catheter withdrawal, which was maintained for 16 days.CONCLUSION: Withdrawal of the urethral catheter 7 days after radical retropubic prostatectomy, without performing cystography, has a low rate of short-term complications that are equivalent to withdrawal 14 days after the surgery.

Use of Disposable Punch Biopsy Device to Add Foley Catheter Fenestration to Improve Drainage of Post Radical Prostatectomy Anastomotic Leak

“…In numerous reports, the length of time for maintaining this catheter has been found to progressively decreased from 21-30 days 12 to 14-21 days 13,14 and more recently to between four and seven days. 8,15,16 When an AL occurs, this urinary colonization can be catastrophic as this bacteria filled urine leaks out of the bladder. Urine is irritating to intra-abdominal organs and the peritoneal lining and if bacteria are present, the risk for infection is a significant concern that can cause sepsis, abscess formation and further tissue and organ damage.…”

Evidências na prática do cateterismo urinário: Revisão Integrativa

“…Remoção de um cateter permanente após 2 dias está associada com mais substituições, deve-se dar preferência a retirada da sonda após 5 dias (1B) 14 Culturas positivas do coletor de urina não são fiáveis para confirmar o diagnóstico de infecção do trato urinário (2A) 17 Retirada da sonda vesical de demora no máximo em 7 dias está associado ao menor número de complicações (2B) 15 Os fatores que causam a infecção são associados com prolongado do cateterismo vesical (3A, 3B) 10,13 Almeida MM, Silva FWT, Lindoso AM, et al …”

In the october 2004 issue of Clínicas

“…SOUTO CAV et al 6 evaluate the hypothesis that a 7-day period of indwelling catheter after radical retropubic prostatectomy is effective and safe without the need of performing cystography. The study included 73 patients.…”