• Louis Spencer Krane, Mahendra Bhandari, James O Peabody, and Mani Menon.
• Vattikuti Urology Institute, Henry Ford Health Systems, Detroit, MI, USA.
• Eur. Urol. 2009 Aug 1; 56 (2): 325-30.

BackgroundPatients undergoing radical prostatectomy (RP) traditionally require urethral catheterization for adequate bladder drainage in the postoperative period. However, many patients have significant discomfort from the urethral catheter.ObjectiveTo describe a technique of percutaneous suprapubic tube (PST) bladder drainage after robotic-assisted laparoscopic radical prostatectomy (RALP) and to evaluate patient discomfort, complications, continence, and stricture rate after this procedure.Design, Setting, And ParticipantsTwo hundred two patients undergoing RALP were drained with a 14F PST instead of a urethral catheter. The PST was placed robotically at the conclusion of the urethrovesical anastomosis and secured to the skin over a plastic button. Beginning on postoperative day 5, patients clamped the PST, urinated per urethra, and measured the postvoid residual (PVR) drained by PST. The PST was removed when residuals were <30 cm(3) per void. The control group consisted of 50 consecutive patients undergoing RALP with urethral catheter drainage.MeasurementsThe primary end point was catheter-associated discomfort as measured with the Faces Pain Score-Revised (FPS-R). Secondary end points included use of anticholinergics, complications related to the PST, urinary continence, and urethral stricture.Results And LimitationsWhen compared with urethral catheter patients, PST patients had significantly decreased catheter-related discomfort on postoperative days 2 and 6 (p<0.001). Anticholinergic medication was required by one PST and four urethral catheter patients (p<0.001). Ten patients required urethral catheterization for PST dislodgement (n=5) or urinary retention (n=5). No patient has developed a urethral stricture at a mean follow-up of 7 mo.ConclusionsPST provides adequate urinary drainage following RALP with less patient discomfort and no increased risk of urethral stricture.

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