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The purpose of this study was to examine if early catheter removal after radical retropubic prostatectomy adversely affects urinary continence. A total of 139 consecutive patients undergoing radical retropubic prostatectomy in 2008 was evaluated. Mean patient age was 65 years.
A cystogram was performed routinely on POD 5. In case of a watertight anastomosis the catheter was removed before the 7th postoperative day (group I, 69,1 %, n=96). The remaining 30,9 % (group II, n=43) showed urine extravasation. In this group the catheter was left in situ for another 8 days or longer if indicated (mean 15,2 days).
Continence was examined by a standardized pad test, the International Consultation of Incontinence Questionnaire-Short Form (ICIQ-SF) and the use of pads/24h preoperative, before discharge the patient from the hospital and at 3 months later. The weight of lost urine (pad-test) was reported and subdivided into 4 groups defined according to the weight of lost urine (continent: urine loss < 2 g). Besides, we investigated if age, body mass index and nerve-sparing technique have an impact on urinary continence. The results of ICIQ-SF we evaluated descriptively by histograms and median. For statistical analysis of pad test we used the Mann-Whitney U-test as non-parametric test for two independent samples. Pearson´s correlation was used to calculate the correlation between urine loss in pad test with age and body mass index. We applied the Mann-Whitney U-test to analyse if there is a statistically significant difference between the urine loss in pad test and nerve-sparing surgery. The significance level was defined as p < 0,05.
In the interpretation of ICIQ-SF the group with delayed catheter removal (group II) experienced more severe incontinence before discharge home than group I. After 3 months the results in both groups were comparable: 91,2 % (group I) vs. 93,3 % (group II) had no or mild urine loss.
Postoperatively 68,1 % (group I) vs. 60,6 % (group II) experienced continence in pad test or fit in the minimal incontinence category (urine loss in pad test < 9 g).
At 3 months 71 % of patients in both groups showed continence. Statistically there was no significant difference. 93,1 % (group I) vs. 90,4 % (group II) experienced continence or mild incontinence (urine loss in pad test < 9 g). Postoperatively mean use of pads/24h was comparable: 3,2 (group I) vs. 3,3 (group II).
In summary, in our patient cohort we could show that delayed catheter removal in patients with anastomotic urine leak may affect continence postoperatively but 3 months later the outcomes are comparable (pad test, ICIQ-SF).