Early Catheter Removal After Robot-assisted Radical Prostatectomy: Results from a Prospective Single-institutional Randomized Trial (Ripreca Study)

Background: The adoption of robotic technology in the treatment of prostate cancer (PCa) could lead to improvement in outcomes. Objective: To evaluate feasibility, to compare functional outcomes, and to assess the economic benefits of removing catheter on the postoperative day (POD) 3 versus POD 5 after robot-assisted radical prostatectomy (RARP). Design, setting, and participants: From September 2016 to May 2017, patients selected to undergo RARP for clinically localized PCa at a high-volume center were prospectively randomized into group 1 (POD 3; n = 72) versus group 2 (POD 5, n = 74). Intervention: All patients underwent RARP with anatomical posterior and anterior reconstruction. Outcome measurements and statistical analysis: The primary endpoint was to compare acute urinary retention (AUR) and urinary leakage rate in the two groups. The secondary endpoints were early and mid-term postoperative functional outcomes assessed through questionnaires (ICIQ-MLUTS, IPSS), early continence rate, and postoperative pain/discomfort (visual analog scale score). The economic impact of early catheter removal was also assessed. Results and limitations: AUR was reported in two (1.4%) cases, one for each study group (p = 0.9). One case of vesicourethral leakage was reported (0.7%) in group 1. Urethral discomfort and pain at discharge was significantly higher in group 2 (p = 0.03). In our clinical practice, POD 3 catheter removal approach would determine a saving of approximately (sic)80 000 and 405 d of hospitalization yearly. The main limitation is the small sample size. Conclusions: Early catheter removal after RARP does not lead to an increase in perioperative complications. No negative effect on early and mid-term functional outcomes was observed. A significant impact on saving economic resources was reported. Patient summary: We demonstrated that early catheter removal has no negative effect on spontaneous voiding, complications, or urinary continence recovery after robot-assisted radical prostatectomy. (C) 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved.