Long‐term follow‐up of patients undergoing percutaneous suprapubic tube drainage after robot‐assisted radical prostatectomy (RARP)

• Published in: BJU international Vol. 110; no. 4; pp. 580 - 585
• Main Authors: Sammon, Jesse D., Trinh, Quoc‐Dien, Sukumar, Shyam, Diaz, Mireya, Simone, Andrea, Kaul, Sanjeev, Menon, Mani
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.08.2012; Wiley-Blackwell; Wiley Subscription Services, Inc
• Subjects: Biological and medical sciences; Bladder; Drainage - instrumentation; Drainage - methods; Equipment Failure; Follow-Up Studies; Humans; Length of Stay; Male; Medical research; Medical sciences; Middle Aged; Mortality; Nephrology. Urinary tract diseases; Organ Size; Patient Satisfaction; Patients; Postoperative Complications - etiology; Prostatectomy - adverse effects; Prostatectomy - methods; Prostatic Neoplasms - pathology; Prostatic Neoplasms - surgery; PST; RARP; robotic prostatectomy; Robotics - methods; suprapubic; suprapubic tube; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the genital tract and mammary gland; Urinary Catheterization - instrumentation; Urinary Catheterization - methods; Urination Disorders - etiology; Human; Nephrology; robotic prostatectomy; RARP; Robotics; Urology; Percutaneous route; suprapubic; PST; Treatment; Telemedicine; Follow up study; Surgery; Suprapubic drain; Prostatectomy; suprapubic tube
• ISSN: 1464-4096; 1464-410X; 1464-410X
• DOI: 10.1111/j.1464-410X.2011.10786.x

Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? •  Initial reports of percutaneous suprapubic tube (PST) drainage following RARP demonstrated feasibility and short‐term safety, while decreasing patient discomfort and utilization of anti‐cholinergic medication. •  This study demonstrates the long‐term safety and efficacy of bladder drainage by PST; splinting the urethrovesical anastomosis is simply not essential if mucosal apposition is ensured. OBJECTIVES •  To evaluate the long‐term safety and functional outcomes of patients undergoing percutaneous suprapubic tube (PST) drainage after robot‐assisted radical prostatectomy (RARP). PATIENTS AND METHODS •  Between January 2008 and October 2009, 339 patients undergoing RARP by one surgeon experienced in RA surgery (M.M.) had postoperative bladder drainage with PST and a minimum of 1‐year follow‐up for urinary function. •  Functional outcomes were obtained via patient‐administered questionnaire. •  Complications were captured by exhaustive review of multiple datasets, including our prospective prostate cancer database, claims data, as well as electronic medical and institutional morbidity and mortality records. RESULTS •  Urinary function assessed by patient‐administered questionnaire was analysed at a mean (sd) follow‐up of 11.5 (1.7) months; after RARP with PST placement, 293 patients (86.4%) had total urinary control and only nine (2.7%) required >1 pad/day. •  In all, 86 patients (25.4%) never wore a pad; the median time to 0–1 pad/day was 2 weeks (interquartile range [IQR] 0,6); median time to total control was 6 weeks (IQR 1,22). •  The mean (sd) follow‐up for complications was 23.7 (6.1) months. In all, 15 patients (4.4%) had a procedure‐specific complication, of which 13 were minor (Clavien Class I/II 3.8%); one patient had a bladder neck contracture. •  In all, 16 patients (4.7%) required Foley placement after RARP for gross haematuria (two patients), urinary retention (three), tube malfunction (four) or need for prolonged Foley catheterization (seven). CONCLUSIONS •  PST placement after RARP is safe and efficacious on long‐term follow‐up. •  Splinting of the urethrovesical anastomosis is not a critical step of RP if a watertight anastomosis and excellent mucosal apposition are achieved.