Is Urethral Catheterization Necessary in Retzius-sparing Robot-assisted Radical Prostatectomy?

OBJECTIVE: To analyze whether urethral catheter-free anastomosis during retzius-sparing radical prostatectomy results in worsening immediate perioperative and postoperative complications.

METHODS: We retrospectively reviewed records of patients undergoing robotic-assisted radical prostatectomy with or without indwelling urethral catheter placement by a single surgeon between January 2020 and March 2022. Clinical and pathological characteristics were evaluated. An independent t-test was used to compare continuous variables, and Pearson's chi-square test or Fisher's exact test was used to compare categorical variables.

RESULTS: 115 patients underwent robotic prostatectomy from January 2020 to June 2022. 62 patients had both a urethral catheter for 12 hours postoperatively and a suprapubic catheter for 6 days, while in 53 patients a urethral catheter was omitted. There was no significant difference noted between the groups regarding age, BMI, ASA, PSA, stage, node status, or positive margins. There were no significant differences in the rates of anastomotic leak, ileus, or urethral stricture. Patients had a significantly higher pad free rate in the suprapubic catheter only group (p=0.04) at 3 months. There was no difference in average number of pads used or the number using more than 1 pad/day.

CONCLUSIONS: Omission of urethral catheterization during retzius-sparing radical prostatectomy is safe and doesn't result in an increased risk in perioperative or postoperative complications, but rather appears to be associated with a significantly improved 3-months pad free rate.