Evaluation of urinary extravasation and results after continence‐preserving radical retropubic prostatectomy

Abstract

OBJECTIVETo evaluate the feasibility of urinary catheter removal 10 days after a radical retropubic prostatectomy (RRP) by assessing the incidence of urinary extravasation and its effect on postoperative stricture and continence rates. PATIENTS AND METHODSDuring a 4.5-year period, 619 patients undergoing RRP were evaluated. If no extravasation was detected on gravity cystography, the urinary catheter was removed 10 days after RRP. In patients with significant extravasation the catheter was left in place for 3 weeks. Overall stricture and continence rates were recorded in patients at 3, 6 and 12 months after surgery. RESULTSThere was extravasation during cystography in 29 patients (4.6%). At 3, 6 and 12 months, continence rates after catheter removal at 10 days were 74.9%, 87.9%, and 93.6%, respectively, while in the late-removal group they were 72.4%, 84.6% and 90.9%, respectively, with no significant difference between the groups. At 3 months the overall continence rate was 74.8% and at 12 months up to 93.5%. There was no difference in stricture rates between the groups, with an overall stricture rate of 0.7%. CONCLUSIONSCatheter removal 10 days after RRP is feasible, giving excellent early and late continence rates, with low anastomotic stricture rates obtained using good surgical technique. Extravasation at 10 days was rare and with proper management did not influence the final results.

Urinary incontinence after radical prostatectomy: incidence by definition, risk factors and temporal trend in a large series with a long‐term follow‐up

“…[13] (16%) when considering a similar definition. However, the present rate is significantly higher than that reported by other large series (6-8%), despite their stricter criteria of continence [14,15,20]. At 24 months of follow-up the present incontinence rate significantly decreased to 6.8%, in the range of those reported from other academic treatment centres, despite the variable definitions of incontinence and surgical techniques [14,15,[21][22][23].…”

Unidirectional barbed suture versus standard monofilament for urethrovesical anastomosis during robotic assisted laparoscopic radical prostatectomy

“…However, this small difference would most likely be clinically insignificant given our relative low percentage of leak. Studies have shown that a majority (79 to 95%) of patients undergoing radical prostatectomy do not have a urine leak by cystogram seven days postoperatively (13)(14)(15). By 15 to 21 days after surgery, nearly 100% of patients do not have a urinary leak at the UVA (13,16).…”

Para‐anastomotic haematoma volume predicts the presence of anastomotic extravasation after radical retropubic prostatectomy

“…Historically, urinary catheters were routinely left indwelling for 2–3 weeks, based on a study assessing anastomotic integrity at various times after RRP [6]. Several investigators recently reported that the urinary catheter can safely be removed 1 week after RRP in the absence of cystographic evidence of anastomotic extravasation [3,7].…”