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<p>To evaluate the safety and early functional outcomes of a urethral catheter–free protocol during extraperitoneal single-site robot-assisted radical prostatectomy (essRARP), enabled by suprapubic catheter (SPC) drainage placed through the existing incision, compared with urethral catheter (UC) drainage. We retrospectively analysed 217 consecutive men undergoing essRARP (June 2023–July 2025) at a single institution. Patients received either a urethral catheter–free protocol with SPC drainage (SPC/UC-free, n = 129) or UC drainage (UC, n = 88). In the SPC/UC-free group, after vesicourethral anastomosis and a negative 150 mL saline leak test, a 14-Fr SPC was inserted under direct vision via the existing incision (no additional skin punctures/incisions), and the UC was removed intraoperatively. Pain (VAS) was assessed on postoperative day 1, at discharge, and on catheter removal day. Immediate continence was defined as 0 pad/day within 24 h after catheter removal. Multivariable logistic regression identified predictors of immediate continence. Baseline and intraoperative characteristics were comparable before matching. In the unmatched cohort, pain scores were similar on postoperative day 1 and catheter removal day, but lower at discharge in the SPC/UC-free group (median [IQR] 1.0 [1.0–2.0] vs 1.5 [1.0–2.0]; P &lt; 0.001). Immediate continence was higher in the SPC/UC-free group (57.4% [74/129] vs 25.0% [22/88]; P &lt; 0.001). After propensity score matching, 87 matched pairs were identified, and the main findings remained directionally consistent, with the SPC/UC-free group showing lower discharge-day pain scores and a higher rate of immediate urinary continence. In multivariable logistic regression analysis, the urethral catheter-free protocol remained independently associated with immediate urinary continence (OR 3.94, 95% CI 2.07–7.48; P &lt; 0.001). Two SPC/UC-free patients developed self-limiting gross haematuria; there were no urinary tract infections, urethral stricture, or readmissions. Urethral catheter–free drainage after essRARP using SPC via the existing incision improved early comfort and immediate continence without an evident short-term safety penalty.</p>

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Do all patients need a urethral catheter after robotic-assisted radical prostatectomy?

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月25日

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  • Binghao Zeng,
  • Yubo Wang,
  • Xinci Ning,
  • Zhuyinjun Zong,
  • Qingfeng Yu,
  • Mingzhao Li,
  • Yongda Liu,
  • Chao Cai,
  • Jiehui Zhong,
  • Tao Xie,
  • Jianfeng Liang,
  • Jianhao Wu,
  • Xuezhi Long,
  • Yueting Huang,
  • Yan Zhao,
  • Viktor Stankov,
  • Shancheng Ren,
  • Guohua Zeng,
  • Di Gu

摘要

To evaluate the safety and early functional outcomes of a urethral catheter–free protocol during extraperitoneal single-site robot-assisted radical prostatectomy (essRARP), enabled by suprapubic catheter (SPC) drainage placed through the existing incision, compared with urethral catheter (UC) drainage. We retrospectively analysed 217 consecutive men undergoing essRARP (June 2023–July 2025) at a single institution. Patients received either a urethral catheter–free protocol with SPC drainage (SPC/UC-free, n = 129) or UC drainage (UC, n = 88). In the SPC/UC-free group, after vesicourethral anastomosis and a negative 150 mL saline leak test, a 14-Fr SPC was inserted under direct vision via the existing incision (no additional skin punctures/incisions), and the UC was removed intraoperatively. Pain (VAS) was assessed on postoperative day 1, at discharge, and on catheter removal day. Immediate continence was defined as 0 pad/day within 24 h after catheter removal. Multivariable logistic regression identified predictors of immediate continence. Baseline and intraoperative characteristics were comparable before matching. In the unmatched cohort, pain scores were similar on postoperative day 1 and catheter removal day, but lower at discharge in the SPC/UC-free group (median [IQR] 1.0 [1.0–2.0] vs 1.5 [1.0–2.0]; P < 0.001). Immediate continence was higher in the SPC/UC-free group (57.4% [74/129] vs 25.0% [22/88]; P < 0.001). After propensity score matching, 87 matched pairs were identified, and the main findings remained directionally consistent, with the SPC/UC-free group showing lower discharge-day pain scores and a higher rate of immediate urinary continence. In multivariable logistic regression analysis, the urethral catheter-free protocol remained independently associated with immediate urinary continence (OR 3.94, 95% CI 2.07–7.48; P < 0.001). Two SPC/UC-free patients developed self-limiting gross haematuria; there were no urinary tract infections, urethral stricture, or readmissions. Urethral catheter–free drainage after essRARP using SPC via the existing incision improved early comfort and immediate continence without an evident short-term safety penalty.