Nina Harke1, Michael Godes2, Jawid Habibzada2, Katarina Urbanova2, Christian Wagner2, Henrik Zecha2, Mustapha Addali2, Jorn H Witt2. 1. Department of Urology, Pediatric Urology and Urologic Oncology - Prostate Center Northwest, St. Antonius Hospital, Moellenweg 22, 48599, Gronau, Germany. harkenina@gmail.com. 2. Department of Urology, Pediatric Urology and Urologic Oncology - Prostate Center Northwest, St. Antonius Hospital, Moellenweg 22, 48599, Gronau, Germany.
Abstract
PURPOSE: To evaluate the impact of the type of urinary diversion (suprapubic vs. transurethral catheterization) on patients' postoperative pain after radical prostatectomy, development of bacteriuria and long-term functional results. METHODS: A randomized, prospective clinical trial was performed including 160 patients who underwentrobot-assisted radical prostatectomy after randomization into two groups: intraoperatively, a transurethral catheter (control group) or an additional suprapubic tube (with removal of the transurethral catheter in the morning of postoperative day 1; intervention group) was placed. Primary study endpoint was postoperative pain objectified by the numeric rating scale questionnaire. Secondary endpoints were bacteriuria after catheter removal and functional outcomes after up to 2 years of follow-up. RESULTS: There were no significant differences in demographic and perioperative data. Starting on postoperative day 2, patients in the suprapubic diversion group had significantly less pain on every time point preceding the removal of the catheter compared to the control cohort with a median overall numeric rating score on postoperative day 1-4 of 2.4 points in the transurethral versus 1.3 in the intervention group (p = 0.012). No statistical difference was found in postoperative bacteriuria and complications as well as in functional results, quality of life and incontinence rates after a median follow-up of 22 months. CONCLUSIONS:Suprapubic drainage in robot-assisted radical prostatectomy shows significantly decreased pain levels during the catheterization period compared to the transurethral diversion without compromising long-term functional results. Intraoperative placement of a suprapubic tube should be discussed as a standard procedure for further improvement of patients' postoperative comfort.
RCT Entities:
PURPOSE: To evaluate the impact of the type of urinary diversion (suprapubic vs. transurethral catheterization) on patients' postoperative pain after radical prostatectomy, development of bacteriuria and long-term functional results. METHODS: A randomized, prospective clinical trial was performed including 160 patients who underwent robot-assisted radical prostatectomy after randomization into two groups: intraoperatively, a transurethral catheter (control group) or an additional suprapubic tube (with removal of the transurethral catheter in the morning of postoperative day 1; intervention group) was placed. Primary study endpoint was postoperative pain objectified by the numeric rating scale questionnaire. Secondary endpoints were bacteriuria after catheter removal and functional outcomes after up to 2 years of follow-up. RESULTS: There were no significant differences in demographic and perioperative data. Starting on postoperative day 2, patients in the suprapubic diversion group had significantly less pain on every time point preceding the removal of the catheter compared to the control cohort with a median overall numeric rating score on postoperative day 1-4 of 2.4 points in the transurethral versus 1.3 in the intervention group (p = 0.012). No statistical difference was found in postoperative bacteriuria and complications as well as in functional results, quality of life and incontinence rates after a median follow-up of 22 months. CONCLUSIONS: Suprapubic drainage in robot-assisted radical prostatectomy shows significantly decreased pain levels during the catheterization period compared to the transurethral diversion without compromising long-term functional results. Intraoperative placement of a suprapubic tube should be discussed as a standard procedure for further improvement of patients' postoperative comfort.
Authors: Khurshid R Ghani; Quoc-Dien Trinh; Jesse D Sammon; Wooju Jeong; Andrea Simone; Ali Dabaja; Stacey Dusik; James O Peabody; Mani Menon Journal: BJU Int Date: 2013-09 Impact factor: 5.588
Authors: Carolyn V Gould; Craig A Umscheid; Rajender K Agarwal; Gretchen Kuntz; David A Pegues Journal: Infect Control Hosp Epidemiol Date: 2010-04 Impact factor: 3.254
Authors: Nina Natascha Harke; Christian Wagner; Nikolaos Liakos; Katarina Urbanova; Mustapha Addali; Boris A Hadaschik; Jorn H Witt Journal: World J Urol Date: 2020-05-02 Impact factor: 4.226