Catheter management related to radical retropubic prostatectomy

The clinical course of 108 consecutive radical retropubic prostatectomy (RRP) patients with regards to postoperative cystograms and suprapubic cystostomy was retrospectively reviewed. All patients had a urethral Foley (UF), suprapubic catheter (SP) and were discharged with both catheters in place. Two of 9 patients who had excessive drainage had biochemical evidence of urine. Cystogram on these 2 patients, deferred till days 19 and 27, was normal. Among the other 7 patients with excessive JP drainage, only 1 showed a minor anastomotic look on day 15, necessitating catheter drainage for 1 additional week, with uneventful Foley removal then. Ten patients showed some degree of extravasation on the initial cystograms, 6 patients were judged to be insignificant and the catheter was removed the same day, 4 patients had extravasation (performed days 7, 13, 15, 22) which warranted repeat cystogram 1 week later, which then turned out to be normal. Five patients experienced problems with the UF early in the postoperative period and the SP served as a backup for bladder drainage. The SP entails negligible morbidity and may serve a useful function in the most critical early postoperative period. Based on our data, routine cystogram prior to catheter removal did not appear to alter the management of the catheters significantly and appears unnecessary, especially if the catheter is left in situ for close to 3 weeks prior to removal. In selected cases where technical anastomotic problems were encountered or if delayed healing was anticipated, a c;ystogram prior to catheter removal would still be available.