Time of catheterization as an independent predictor of early urinary continence recovery after radical prostatectomy.

BACKGROUND

The purpose of the present study was to investigate the potential impact of catheter removal time on immediate and early urinary continence recovery in a series of patients who underwent radical prostatectomy (RP).

METHODS

We prospectively collected and analyzed the clinical records of 197 patients who underwent open RP between January 2014 and December 2016. A single surgeon using the urethral fixation technique performed all procedures. Patients receiving surgery between Monday and Wednesday performed a cystogram on postoperative day (POD) 2. Conversely, other cases treated on a Thursday or Friday performed a cystogram on the following Monday (POD 3 or 4). The catheter removal was planned the day after the cystogram if there was a watertight anastomosis or with a little extravasation (<5%). Urinary continence recovery was evaluated 1 week, 1, 2 and 3 months after catheter removal. Patients self-reporting no urine leak were considered continent. Logistic regression analysis was used to identify independent predictors of urinary continence recovery at different follow-up durations.

RESULTS

The median catheterization time was 3 (IQR: 3-4.2) days and acute urinary retention (AUR) was observed in 13 (6.5%) cases. At median follow-up of 12 (IQR: 9-12) months, no case of bladder neck contracture was observed. Urinary continence probabilities were 43%, 63%, 87%, 91% and 95% after 1 week, 1, 3, 6, and 12 months, respectively. On multivariable analyses, time of catheter removal was an independent predictor of urinary continence recovery after 1 week (OR 1.2; P=0.02); 1 month (OR 1.2; P=0.01); 3 months (OR 1.1; P=0.04) and 6 months (OR 1.1; P=0.03) after catheter removal.

CONCLUSIONS

Time of catheterization should be considered as a postoperative parameter able to influence the immediate and early urinary continence recovery in patients undergoing RP. The impact of new surgical techniques on urinary continence recovery should be tested also considering such potential confounding factor.