Is a cystogram necessary after robot-assisted radical prostatectomy?

Robot-assisted radical prostatectomy has become an acceptable option for the treatment of clinically localized prostate cancer. The role of cystography in robot-assisted radical prostatectomy was evaluated prospectively.

A total of 80 consecutive patients who underwent robot-assisted radical prostatectomy with an intraperitoneal approach were evaluated. There were 40 patients (group 1/surgeon A) who received a routine postoperative cystogram before Foley catheter removal. An additional 40 patients (group 2/surgeon B) had their catheters removed without radiographic imaging. Patient demographics, intraoperative data, postoperative data, and complications were recorded prospectively.

The 2 groups were similar in age, Gleason score, and history of previous urethral/bladder neck surgery. Univariate analysis showed no statistical difference among case duration, estimated blood loss, need for bladder neck reconstruction, presence of visible anastomotic leak, or use of pelvic drains. Anastomosis time was the only variable that reached statistical significance. Mean catheter duration (11 days) was similar between the 2 groups. There were 3 patients from group 1 who had an anastomotic leak identified on a cystogram. In group 2, 1 patient had a persistent mild leak based on a cystogram obtained for urinary symptoms. No patient in either group had urinary retention, urinary tract infection, renal failure, or bladder neck contracture develop. The degree of postoperative urinary incontinence was similar between groups.

Foley catheter removal on postoperative days 8-10 after robot-assisted radical prostatectomy without routine cystography appears safe.