Tag Archives: catheter

Safe removal of the urethral catheter 2 days following laparoscopic radical prostatectomy – Abstract | Prostate Cancer | UroToday | Urology Information

Results:Of the 114 patients who underwent laparoscopic prostatectomy, 64 56% were deemed suitable for removal of catheter on second postoperative day prior to discharge. The first 20 patients selected for early removal of urethral catheter were covered with a suprapubic catheter inserted at the time of surgery. Out of 64 patients deemed suitable for early removal of urethral catheter, 53 83% were able to pass urine without complication. 11 patients 17% developed urinary retention that necessitated recatheterisation. In all cases, reinsertion of catheter was performed easily and successfully without the need for cystoscopic guidance or adjuncts.

via Safe removal of the urethral catheter 2 days following laparoscopic radical prostatectomy – Abstract | Prostate Cancer | UroToday | Urology Information.

 

This study looked at patients who were deemed suitable to have their catheters removed after 2 days of laparoscopic prostatectomy.  This was not done robotically, which makes the skill of the surgeons in accurate suturing very impressive.  They had a relatively high re-cathetrization rate of 17%.  I wonder if these patients were still in the hospital on day number 2.  Urinary retention is a bigger deal if the patient is at home and has to come to the office or emergency room for catheter reinsertion.

I did not read the paper, just the abstract, but I assume they did not perform any reconstructive techniques that I have been performing since 2007.  This reconstructive work makes the bladder neck more fixed and I have not seen very much retention (2-3%) when I have removed catheters after 2-3 days after dvP.

Catheter withdrawal and suturing times of connection during robotic prostatectomy

UroToday – WCE 2007 – Single Knot Anastomosis (SKA) For Laparoscopic Radical Prostatectomy: An International Multicenter Outcome Survey of 5235 Cases

They have shown that the time to complete the anastomosis for the expert, second generation, and trainee surgeons were 16, 23, and 30 minutes respectively. Additional stitches were necessary only in 1.1%. The anastomosis was water tight in 94.2%.
Early leakage requiring prolonged catheter drainage occurred 6.8% of laparoscopic cases and 0% in the robotic assisted cases. Mean catheter time was 7.1 days. The bladder neck contracture rate was 0.8% at 12 months and the rate of acute urinary retention was 0.5%.

Dr. van Velthoven deserves credit dor being the first to devise a simpler, likely better way to make the bladder to urethra connection. Most surgeons, including myself, use this technique.

This large series shows the average time for a connection is 16 minutes and the average catheter is kept in for 1 week.

Some surgeons catheter times are much faster. I have watched Dr Patel and Dr Tewari perform the connection in well under 10 minutes, probably about 5.

My main work currently is trying to reduce the catheter time to as a few days as possible. I think with robotics we can cut down the catheter time to 3 days at least.