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  • Title: Impact of percutaneous suprapubic tube drainage on patient discomfort after radical prostatectomy.
    Author: Krane LS, Bhandari M, Peabody JO, Menon M.
    Journal: Eur Urol; 2009 Aug; 56(2):325-30. PubMed ID: 19394131.
    Abstract:
    BACKGROUND: Patients undergoing radical prostatectomy (RP) traditionally require urethral catheterization for adequate bladder drainage in the postoperative period. However, many patients have significant discomfort from the urethral catheter. OBJECTIVE: To describe a technique of percutaneous suprapubic tube (PST) bladder drainage after robotic-assisted laparoscopic radical prostatectomy (RALP) and to evaluate patient discomfort, complications, continence, and stricture rate after this procedure. DESIGN, SETTING, AND PARTICIPANTS: Two hundred two patients undergoing RALP were drained with a 14F PST instead of a urethral catheter. The PST was placed robotically at the conclusion of the urethrovesical anastomosis and secured to the skin over a plastic button. Beginning on postoperative day 5, patients clamped the PST, urinated per urethra, and measured the postvoid residual (PVR) drained by PST. The PST was removed when residuals were <30 cm(3) per void. The control group consisted of 50 consecutive patients undergoing RALP with urethral catheter drainage. MEASUREMENTS: The primary end point was catheter-associated discomfort as measured with the Faces Pain Score-Revised (FPS-R). Secondary end points included use of anticholinergics, complications related to the PST, urinary continence, and urethral stricture. RESULTS AND LIMITATIONS: When compared with urethral catheter patients, PST patients had significantly decreased catheter-related discomfort on postoperative days 2 and 6 (p<0.001). Anticholinergic medication was required by one PST and four urethral catheter patients (p<0.001). Ten patients required urethral catheterization for PST dislodgement (n=5) or urinary retention (n=5). No patient has developed a urethral stricture at a mean follow-up of 7 mo. CONCLUSIONS: PST provides adequate urinary drainage following RALP with less patient discomfort and no increased risk of urethral stricture.
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