Superior early and long-term continence following early micturition on day 2 after robot-assisted radical prostatectomy: a randomized prospective trial.

PURPOSE: To elucidate early and long-term continence and patient comfort depending on type and duration of catheterization after robot-assisted radical prostatectomy. METHODS: 198 patients were randomized prospectively into three groups (May 2016-July 2017): A transurethral catheter with micturition on postoperative day (POD) 5 was placed in the control group (TD5); a suprapubic tube (SPT) with micturition on POD 5 was placed in the group SD5 or with micturition on POD 2 in group SD2, respectively. Questionnaires were used for catheter-related satisfaction. Functional outcome analysis included residual volume analysis, uroflowmetry, IPSS, 12-h pad test, and daily pad use. Follow-up was conducted up to 12 months. RESULTS: Postoperative comfort and catheter-related complications were similar in the three groups. However, on the day of catheter removal, continence was significantly better in the 12-h pad test for the SD2 group with 14 ml vs. 30 ml (TD5) and 24 ml (SD5), p = 0.007. Median residual urine volume between the groups was comparable with 17 ml in TD5, 7 ml in SD5, and 11 ml in SD2, (p = 0.07). Postoperative IPSS did not differ significantly in the follow-up period. After 4 weeks, 63% of the patients in SD2 were continent (no pad/day) compared to 33% in TD5 and 41% in SD5, p = 0.004. After 12 months, 76% were continent in TD5, 87% in SD5, and 94% in SD2, p = 0.023. CONCLUSIONS: Early micturition after SPT placement in robotic radical prostatectomy seems to be beneficial without an increased risk of complications.

Suprapubic Versus Urethral Catheter for Urinary Drainage After Robot-Assisted Radical Prostatectomy.

PURPOSE OF REVIEW: To review the evidence regarding the usage of suprapubic tube (SPT) versus indwelling urethral catheter (IUC) after robot-assisted radical prostatectomy (RARP). RECENT FINDINGS: Available data on the use of SPT for urinary drainage after RARP is somewhat limited mostly because of the variations of study designs and non-standardized outcomes. Although it may provide some mild benefit in terms of catheter-related pain and discomfort, the benefit seems not to be clinically significant. The evidence in the literature so far does not support routine usage of SPT as the primary urinary drainage method after RARP. Further higher-quality studies that can show clinically significant advantages over IUC are still needed to justify its usage.

Common genitourinary catheters: a systematic approach for the radiologist.

Catheters are commonly used to treat and diagnose urinary tract abnormalities in the pediatric population. This pictorial essay reviews commonly placed genitourinary catheters imaged by radiography, fluoroscopy, computed tomography (CT) and ultrasonography (US). The purpose of the catheter, how the catheter is placed, and the imaging findings associated with appropriately positioned catheters as well as misplaced and displaced catheters are described. It is important for radiologists to recognize common genitourinary catheters, and be familiar with their normal and abnormal positions as displacement is often first recognized by diagnostic imaging.

[Suprapubic tube drainage versus transurethral catheterization after robot-assisted radical prostatectomy: A systematic review and meta-analysis].

OBJECTIVE: To compare the effectiveness and safety of suprapubic tube drainage (SPT) with those of transurethral catheterization (TUC) after robot-assisted radical prostatectomy (RARP). METHODS: We searched PubMed, EMBASE, Cochrane Library, CNKI, VIP, WanFang Data and China Biology Medicine Disc from their inception to December 2017 for randomized controlled trials and cohort studies comparing the effectiveness and safety of SPT and TUC after RARP. Two reviewers independently screened the literature, extracted data and assessed the risk of bias of the included studies, followed by a meta-analysis with the RevMan 5.3 software. RESULTS: Ten studies met the eligibility criteria and were included in this meta-analysis, involving 1 248 cases of RARP, 482 in the SPT group and the other 766 in the TUC group. The severity of postoperative penile pain was significantly lower in the SPT than in the TUC group (RR = 0.63, 95% CI: 0.50 to 0.80, P = 0.0002), but no statistically significant differences were shown between the two groups in the overall pain severity at 1－3 days (［MD = －0.26, 95% CI: －1.34 to 0.83, P = 0.64］ and 6－7 days postoperatively (［MD = －0.50, 95% CI: －1.54 to 0.54, P=0.34］, urinary incontinence (RR = 0.80, 95% CI: 0.56 to 1.15, P = 0.23), bacteriuria (RR = 0.63, 95% CI: 0.20 to 1.97, P = 0.42), bladder neck contracture (RR = 0.77, 95% CI: 0.39 to 1.53, P = 0.45), urethral stricture (RR = 1.32, 95% CI: 0.08 to 20.7, P = 0.84), anastomotic stricture (RR = 0.20, 95% CI: 0.02 to 1.79, P = 0.15), or urinary retention (RR = 0.93, 95% CI: 0.43 to 2.00, P = 0.85). CONCLUSIONS: SPT after RARP is associated with a lower severity of postoperative penile pain than TUC, but there are no statistically significant differences between the two strategies in other parameters. This conclusion, however, has to be further supported by more higher-quality randomized controlled trials.

Postoperative patient comfort in suprapubic drainage versus transurethral catheterization following robot-assisted radical prostatectomy: a prospective randomized clinical trial.

PURPOSE: To evaluate the impact of the type of urinary diversion (suprapubic vs. transurethral catheterization) on patients' postoperative pain after radical prostatectomy, development of bacteriuria and long-term functional results. METHODS: A randomized, prospective clinical trial was performed including 160 patients who underwent robot-assisted radical prostatectomy after randomization into two groups: intraoperatively, a transurethral catheter (control group) or an additional suprapubic tube (with removal of the transurethral catheter in the morning of postoperative day 1; intervention group) was placed. Primary study endpoint was postoperative pain objectified by the numeric rating scale questionnaire. Secondary endpoints were bacteriuria after catheter removal and functional outcomes after up to 2 years of follow-up. RESULTS: There were no significant differences in demographic and perioperative data. Starting on postoperative day 2, patients in the suprapubic diversion group had significantly less pain on every time point preceding the removal of the catheter compared to the control cohort with a median overall numeric rating score on postoperative day 1-4 of 2.4 points in the transurethral versus 1.3 in the intervention group (p = 0.012). No statistical difference was found in postoperative bacteriuria and complications as well as in functional results, quality of life and incontinence rates after a median follow-up of 22 months. CONCLUSIONS: Suprapubic drainage in robot-assisted radical prostatectomy shows significantly decreased pain levels during the catheterization period compared to the transurethral diversion without compromising long-term functional results. Intraoperative placement of a suprapubic tube should be discussed as a standard procedure for further improvement of patients' postoperative comfort.

Options for independent bladder management in patients with spinal cord injury and hand function prohibiting intermittent catheterization.

AIMS: Choosing the appropriate bladder management strategy for the spinal cord injury patient with neurogenic bladder and hand function prohibitive of self catheterization (urethral or stomal) catheterization is complex and based on limited literature. We have catalogued the available data in this review. METHODS: A literature review was conducted on external sphincterotomy, suprapubic tube, ileal conduit, and ileovesicostomy between 1994 and 2012. Articles on neurogenic bladder focused primarily on spinal cord injury were included. Important aspects of each technique, patient selection, urologic events, and quality of life are described. CONCLUSION: The available literature consists primarily of level 3 data. Patient reported outcomes were rarely measured. External sphincterotomy is a good option for males who are candidates for an external catheter and who wish to avoid a complicated reconstruction-most will need re-operations for failure. Suprapubic tube is an option in both genders. Complaints usually involve urine leakage and urinary tract infection, which typically resolve with conservative measures. There is some evidence to support patient satisfaction. Ileal conduit is an option for all patients with quadriplegia, offering continuous drainage and absence of foreign material. Many providers and patients will choose more conservative options first. The ileovesicostomy is best applied to small bladders with severe overactivity. The "reversibility" of this procedure makes it attractive to those not interested in an ileal conduit and who have had complications from prolonged suprapubic tube placement. The authors conclude with recommendations for future research, most importantly more standard reporting of objective data.

Return to urinary continence and sexual function after pelvic fracture-urethral injury - A young woman's years-long journey.

Pelvic fracture urethral injury (PFUI) is a rare condition that can have severe short and long-term consequences. Though it is rare, it is essential to consider this diagnosis with a high index of suspicion in the setting of pelvic trauma. With appropriate management, patients may have a successful return to normal urinary and sexual functions even after devastating injury and urethral obliteration.

Neurogenic bladder: management of the severely impaired patient with complete urethral destruction: ileovesicostomy, suprapubic tube drainage or urinary diversion-is one treatment modality better than another?

BACKGROUND: Management of the severely impaired patient (pt) with a neurogenic bladder (NGB) and complete urethral destruction employs three therapeutic options; bladder neck closure (BNC) with ileovesicostomy, BNC with suprapubic tube (SPT) placement or in pts with an end-stage bladder, cystectomy with enteric conduit diversion. This paper was performed to test the hypothesis that pts managed with an ileovesicostomy would have the best long-term prognosis. METHODS: Patients with a NGB and complete urethral destruction managed between 1986-2018 were reviewed. Three treatment populations were assessed, pts treated with BNC with ileovesicostomy, BNC with SPT placement or cystectomy with enteric conduit diversion. A minimal follow-up interval of 2 years was necessary to be entered into the study. The number of uroseptic episodes, development of urolithiasis, the onset of new renal scars, ≥ stage 3 chronic renal failure, or need for additional surgery were recorded. Statistical evaluations used either chi-squared contingency table analysis, Fisher's exact 2-tailed tests, or Kaplan-Meier curve analysis where indicated. P values of <0.05 were considered significant. RESULTS: Ten pts were managed by cystectomy, and enteric conduit, 17 by BNC and ileovesicostomy and 21 by BNC and SPT placement, median follow up of 8 yrs (range, 2-30 yrs). No significant differences between the three groups regarding the development of urolithiasis (30%, 3/10 pts; 53%, 9/17 pts; 52%, 11/21 pts; respectively), new onset of renal scarring (30%, 6/20 kidneys; 41%, 14/34 kidneys; 45%, 19/42 kidneys; respectively) or stage 3 chronic renal failure (40%, 4/10 pts; 47%, 8/17 pts; 24%, 5/21 pts; respectively. However, the number of hospitalizations for uroseptic episodes significantly increased in patients managed with an ileal conduit (60%, 6/10 pts) and ileovesicostomy (82%; 14/17 pts) compared to those maintained with a SPT (29%, 6/21 pts) P=0.025 and 0.006, respectively. When evaluating the need for delayed surgical intervention due to either urolithiasis or other complications, a total of 50% (5/10 pts) of the patients managed by an ileal conduit, 88% (15/17 pts) of the ileovesicostomy and 52% (11/21 pts) of the patients with a SPT required additional operations. In essence, significantly more pts undergoing BNC and ileovesicostomy required delayed surgical interventions for complications arising from the surgery compared to patients managed with either a cystectomy and ileal conduit (P=0.0285) or BNC and SPT placement (P=0.0180). CONCLUSIONS: In severely impaired pts with a NGB and urinary outlet destruction, BNC and ileovesicostomy are associated with a significantly increased incidence of urosepsis and late surgical complications that required operative intervention compared to alternative treatments. This finding has resulted in the abandonment of the ileovesicostomy from our surgical armamentarium.

Neurogenic bladder associated with xeroderma pigmentosum type A: A case report and literature review.

Xeroderma pigmentosum (XP) is a rare autosomal recessive disease caused by a defect in deoxyribonucleic acid repair. Along with cutaneous symptoms, neurological symptoms are important clinical features of XP. However, information on neurogenic bladder occurrence among XP cases is rare. Herein, we describe a case of neurogenic bladder in a patient with XP type A (XPA). In this case, low bladder compliance, impaired bladder emptying, and urethral sphincter discoordination were significant cystometric findings, and frequent febrile urinary tract infection was a clinical problem. XPA patients often cannot express their symptoms because of cognitive dysfunction. Close follow-up and assessments are necessary.

The case against primary endoscopic realignment of pelvic fracture urethral injuries.

OBJECTIVES: To review previous reports and present our experience on the outcomes after treating pelvic fracture urethral injuries (PFUIs) with primary endoscopic realignment (PER) vs. placing a suprapubic tube (SPT) with elective bulbomembranous anastomotic urethroplasty (BMAU). METHODS: We reviewed previous reports and identified articles that reported outcomes after PER vs. SPT and elective BMAU for patients who sustained PFUIs. We also present our institutional experience of treating patients who were referred after undergoing either form of treatment. RESULTS: The success rates for PER after PFUI are wide-ranging (11-86%), with variable definitions for a successful outcome. At our institution, for patients treated by SPT/BMAU, the mean time to a definitive resolution of stenosis was dramatically shorter (6 months, range 3-15) than for those treated with PER (122 months, range 4-574; P < 0.01). The vast majority of patients treated by PER required multiple endoscopic urethral interventions (median 4, range 1-36;P < 0.01) and/or had various other adverse events that were rare among the SPT/BMAU group (14/17, 82%, vs. 2/23, 9%;P < 0.05). CONCLUSION: While PER occasionally results in urethral patency with no need for further intervention, the risk of delay in definitive treatment and the potential for adverse events have led to a preference for SPT and elective BMAU at our institution.

The management of the acute setting of pelvic fracture urethral injury (realignment vs. suprapubic cystostomy alone).

BACKGROUND: In patients with pelvic fracture urethral injury there are two options for management: First, to realign as an early primary realignment over a catheter; and second, to place a suprapubic tube with delayed urethroplasty of the inevitable stricture. METHODS: We reviewed previous reports from 1990 to the present, comparing early endoscopic realignment, early open realignment and suprapubic tube placement, to determine the rates of incontinence, erectile dysfunction and stricture formation. RESULTS: Twenty-nine articles were identified. The rates of erectile dysfunction, incontinence, and stricture formation, respectively, were: for early endoscopic realignment, 20.5%, 5.8% and 43.8%; for open realignment over a catheter, 16.7%, 4.7% and 48.9%; and for a suprapubic tube and delayed urethroplasty 13.7%, 5.0%, and 89.0%. A one-way anova showed no difference in the mean rate of erectile dysfunction (P = 0.53) or incontinence (P = 0.73), and only stricture formation was significantly different (P < 0.1). CONCLUSION: The rates of incontinence and erectile dysfunction are similar between the groups. Only the rate of stricture formation was higher in the suprapubic tube and delayed urethroplasty group.