Long-term follow-up of patients undergoing percutaneous suprapubic tube drainage after robot-assisted radical prostatectomy (RARP)

摘要

Objectives To evaluate the long-term safety and functional outcomes of patients undergoing percutaneous suprapubic tube (PST) drainage after robot-assisted radical prostatectomy (RARP). Patients and Methods Between January 2008 and October 2009, 339 patients undergoing RARP by one surgeon experienced in RA surgery (M.M.) had postoperative bladder drainage with PST and a minimum of 1-year follow-up for urinary function. Functional outcomes were obtained via patient-administered questionnaire. Complications were captured by exhaustive review of multiple datasets, including our prospective prostate cancer database, claims data, as well as electronic medical and institutional morbidity and mortality records. Results Urinary function assessed by patient-administered questionnaire was analysed at a mean (sd) follow-up of 11.5 (1.7) months; after RARP with PST placement, 293 patients (86.4%) had total urinary control and only nine (2.7%) required >1 pad/day. In all, 86 patients (25.4%) never wore a pad; the median time to 0-1 pad/day was 2 weeks (interquartile range [IQR] 0,6); median time to total control was 6 weeks (IQR 1,22). The mean (sd) follow-up for complications was 23.7 (6.1) months. In all, 15 patients (4.4%) had a procedure-specific complication, of which 13 were minor (Clavien Class I/II 3.8%); one patient had a bladder neck contracture. In all, 16 patients (4.7%) required Foley placement after RARP for gross haematuria (two patients), urinary retention (three), tube malfunction (four) or need for prolonged Foley catheterization (seven). ConclusionS PST placement after RARP is safe and efficacious on long-term follow-up. Splinting of the urethrovesical anastomosis is not a critical step of RP if a watertight anastomosis and excellent mucosal apposition are achieved.