OBJECTIVES: To determine whether radical prostatectomy requires urinary drainage. METHODS: All patients with clinically localized prostate cancer had complete clinical and pathologic information recorded prospectively in a database. The criteria for omission of pelvic drainage were successful bladder neck preservation; urethrovesical anastomosis performed using 6 interrupted sutures in open cases or 12 continuous sutures in robotic cases; and a watertight urethrovesical anastomosis on irrigation. Most patients were discharged on the first or second postoperative day. The catheters were removed routinely on postoperative day 9. RESULTS: A pelvic drain was not placed in 78% of 325 consecutive patients. A drain was omitted in 73% of 225 open cases and 90% of 100 robotic cases. The recovery of continence and the complication rates were similar between the two groups with and without pelvic drainage. Complications occurred in 11% of the group with pelvic drainage and 6% in the group without pelvic drainage. In the past 2 years, 17 of 126 patients required pelvic drainage. The frequency of complications in robotic versus open procedures was similar (chi-square test, P >0.05). CONCLUSIONS: Pelvic drainage may be omitted after radical prostatectomy when the urethrovesical anastomosis is performed well. Drainage omission could contribute to shortened hospital stays and reduced costs, without added complications. These benefits can be extended safely to patients undergoing open or robotic radical prostatectomy.
OBJECTIVES: To determine whether radical prostatectomy requires urinary drainage. METHODS: All patients with clinically localized prostate cancer had complete clinical and pathologic information recorded prospectively in a database. The criteria for omission of pelvic drainage were successful bladder neck preservation; urethrovesical anastomosis performed using 6 interrupted sutures in open cases or 12 continuous sutures in robotic cases; and a watertight urethrovesical anastomosis on irrigation. Most patients were discharged on the first or second postoperative day. The catheters were removed routinely on postoperative day 9. RESULTS: A pelvic drain was not placed in 78% of 325 consecutive patients. A drain was omitted in 73% of 225 open cases and 90% of 100 robotic cases. The recovery of continence and the complication rates were similar between the two groups with and without pelvic drainage. Complications occurred in 11% of the group with pelvic drainage and 6% in the group without pelvic drainage. In the past 2 years, 17 of 126 patients required pelvic drainage. The frequency of complications in robotic versus open procedures was similar (chi-square test, P >0.05). CONCLUSIONS: Pelvic drainage may be omitted after radical prostatectomy when the urethrovesical anastomosis is performed well. Drainage omission could contribute to shortened hospital stays and reduced costs, without added complications. These benefits can be extended safely to patients undergoing open or robotic radical prostatectomy.
Authors: John E Musser; Melissa Assel; Giuliano B Guglielmetti; Prachee Pathak; Jonathan L Silberstein; Daniel D Sjoberg; Melanie Bernstein; Vincent P Laudone Journal: J Endourol Date: 2014-07-24 Impact factor: 2.942