Comparison of self-removal and clinic-removal of catheter after Robot-Assisted Laparoscopic prostatectomy

Prostate cancer is the most common cancer in men, with Robot-Assisted Laparoscopic Prostatectomy (RALP) a common treatment for localised cases. Postoperative catheterisation is routine, with removal typically occurring in hospital (Trial Without Catheter, TWOC). Home-based catheter removal (home-TWOC) is a newer option offering potential benefits in patient experience, clinic capacity and sustainability, though evidence remains limited. This service evaluation examined the effectiveness of a home-TWOC programme for post-RALP patients, assessing clinical outcomes - including re-catheterisation, urinary tract infections (UTIs) and other complication - and comparing them to clinic-TWOC. It also explored patient experiences and potential economic benefits.

Using a cross-sectional design, the service evaluation included retrospective and prospective arms with convenience sampling. The prospective cohort consisted of all post-RALP patients from a single UK centre over 16 weeks from January 8, 2024. The retrospective group covered the 16 weeks from February 1, 2022, immediately prior to the programme's launch. Quantitative data from clinical audits were calculated using the Agresti-Coull method. Qualitative data, collected via questionnaires, were analysed descriptively and thematically.

Findings showed home-TWOC to be safe and effective, with no re-catheterisations or UTIs reported. Patient satisfaction was high, with most willing to repeat the process. Though sample size limited statistical power, outcomes aligned with existing studies. Minor concerns included anxiety, pain and information clarity. Improvements in patient education, support resources and staff training were identified, along with indicative benefits.

Home-TWOC is a safe, effective and well-received alternative to clinic-based catheter removal, offering clinical, economic and experiential benefits for post-RALP patients.