Tewari A et al. (2008) Catheter-less robotic radical prostatectomy using a custom-made synchronous anastomotic splint and vesical urinary diversion device: report of the initial series and perioperative outcomes. BJU Int 102: 1000–1004

Urethral catheterization is necessary after robotic radical prostatectomy, but can, however, lead to pain, discomfort and infection. Tewari and colleagues, therefore, conducted a pilot study to investigate whether suprapubic catheterization might be a feasible alternative.

A custom-made tube was developed with a small anastomotic splint, two balloons to prevent movement, and multiple holes for bladder drainage. The device was retractable to allow a voiding trial before removal.

The researchers assessed 30 patients undergoing robotic radical prostatectomy for early-stage prostate cancer. Of these participants, 10 patients underwent suprapubic catheterization and 20 were fitted with the conventional Foley catheter. Catheters were removed after 7 days, and urethral symptoms were recorded with patient questionnaires. No differences were observed between groups in terms of console times, blood loss, or retention rates. No patients in the suprapubic drainage group experienced pain in the penile shaft or tip, compared with 18 patients in the conventional catheterization group. Fewer catheter-less patients reported bladder spasms (1 vs 8) and discomfort walking and sleeping (2 vs 14). Neither groups experienced any complications.

Tewari et al. state that the benefits of suprapubic over conventional catheterization include a reduction in infection risk, an earlier return to normal function and normal activity, and improved patient satisfaction. The authors recommend that these findings be confirmed in a larger randomized study.