Early catheter removal after Retzius-sparing robot-assisted radical prostatectomy

To assess the feasibility of early catheter removal (< 3 days; ECR) after Retzius-sparing robot assisted radical prostatectomy (RS-RARP).

Patients with non-metastatic prostate cancer without prior prostate surgery who underwent RS-RARP were assessed for reasons for the direct decision of delayed catheter removal (> 3 days; ddDCR). Furthermore, differences in patient characteristics and retention rate when the catheter was removed after 2 days (very ECR; VECR) or 3 days (standard ECR; SECR) were assessed and predictors of retention in the ECR were analyzed.

Out of 343 patients, 31 patients (9%) needed ddDCR mainly due to anastomotic leakage or complex cases. Respectively 238 and 74 patients underwent SECR and VECR. Patients with VECR had significantly shorter operation time, more favorable risk group stratification, and more frequent bladder neck sparing compared to SECR. Patients after VECR had a significantly shorter hospital stay compared to SECR (2 versus 3 days; p < 0.001). The retention rate after VECR, SECR, and ddDCR was respectively 17.6%, 10.1%, and 3.2% (p = 0.084). There were no significant differences in patient-reported continence rates among groups. Retention could not predict continence. No predictor for retention could be identified.

ECR is possible in the large majority of patients undergoing RS-RARP. VECR is possible in selected patients and reduces hospital stay. However, the risk of retention after ECR should be informed. These results provide reliable evidences for perioperative management decisions in RS-RARP.