Impact of Percutaneous Suprapubic Tube Drainage on Patient Discomfort after Radical Prostatectomy

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. (C) 2009 European Association of Urology. Published by Elsevier B.V. All rights reserved.