Who Needs a Postoperative Radiological Anastomotic Control following Radical Prostatectomy before Catheter Removal on...

Patients desire postoperative transurethral catheter removal as early as possible after radical prostatectomy (RP). Therefore, we strived to obtain risk factors for radiographic anastomotic leakage (AL) at postoperative day 3 (POD3) to assess whether a cystogram (CG) before removal is still necessary in all patients.

We retrospectively analyzed the data of 409 patients undergoing RP at our clinic in 01-06/2022. Out of these, 334 were included for further analysis. Patients with a robotic-assisted approach (RARP) received their CG on POD3 as standard, after open surgery (ORP) on day 5. We employed univariable analyses to examine potential risk factors for AL, such as surgical approach, intraoperative bladder neck reconstruction, obesity, or locally advanced disease stages.

In total, the rate of AL was low: 22/334 (6.7%) patients showed extravasation on initial standard (POD3, 5) CG after RP. Only surgical approach (ORP 30% vs. RARP: 5.1% p < 0.001, odds ratio [OR] 0.12, 95% confidence interval [CI] 0.04-0.37, p < 0.001) and need for bladder neck reconstruction (5.6% vs. 16.7%, p = 0.02, OR 0.30, 95% CI 0.10-0.87, p = 0.027) could be determined as risk factor for AL. None of the other factors showed statistically significant associations.

Omitting CG at POD3 following RP would miss approximately 7% of AL. It is unclear whether this would always cause disruption and urinoma. Since catheterization time for safe removal without CG has yet to be defined, we recommend early CG for all patients. Early catheter removal has a 5% risk for acute urinary retention.