New Technique Eases Post-Prostatectomy Recovery

A new catheter-less technique used in conjunction with robotic prostate cancer surgery eliminates the pain and discomfort associated with recovery from the procedure.

Researchers from New York Presbyterian/Weill Cornell School of Medicine (NYP, New York, NY, USA) studied a group of 30 patients; ten of the patients were implanted with a custom-made suprapubic catheter, which provided a small anastomotic splint. The second group of 20 patients served as a control group who had standard urethral catheterization with an 18 F Silastic Foley catheter. Demographic, intraoperative, and outcome data were measured and analyzed. The two groups were comparable in age, prostate specific antigen (PSA) level, body mass index (BMI), the grade and stage of the cancer, length of surgery, blood loss, and several other operative measures. Urethral symptoms were recorded using a specially developed questionnaire. The results showed that the control group experienced penile pain and discomfort nine times greater than the experimental group, and seven times greater discomfort while walking and sleeping. No patient in either group had hematuria or clot retention requiring irrigation, and there were no serious side effects observed in either group. The study was published in the October 2008 issue of the British Journal of Urology International (BJUI).

"Robotic surgery offers better cosmetic benefits, reduced pain, early continence, a high rate of sexual potency, and minimal blood loss, all without sacrificing the success of cancer elimination,” said lead author Ashutosh K. Tewari, M.D., director of robotic prostatectomy and outcomes research at NYP.

The new approach avoids implantation of an irritating catheter through the penis' urethra and re-routes urine directly from the bladder by way of a suprapubic diversion with a urethral splint, multiple holes for drainage, and the ability to retract the splint to give a voiding trial before removing the drainage device. The device exits the body through a small needle puncture below the gut, and also serves to support the internal urinary structures as the patient heals. Avoiding the use of a catheter imparts less risk for bacterial infection, reduces discomfort, and reduces the need for re-catheterization.

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NewYork Presbyterian/Weill Cornell School of Medicine