New technique enables patients to leave hospital without a catheter

2nd June 2009

We have recently introduced a new technique which provides an alternative to wearing an uncomfortable and often painful urethral catheter for a week after surgery.

This technique enables the majority of patients to have their urethral catheter removed 12 hours after surgery and go home without a catheter.

Patients often report pain and discomfort from the urethral catheter as one of the most difficult aspects of a prostatectomy.

A urethral catheter is a thin tube which is inserted into the penis and up into the bladder in order to drain urine from the body.

Traditionally, the urethral catheter stays in place for around seven days after the operation. Patients often find the urethral catheter painful and difficult to use.

We have adopted a technique developed in the US where a drainage device, called a suprapubic catheter, is inserted into the lower abdomen.

This has several benefits for patients. The urethral catheter is removed 12 hours after the operation. The suprapubic catheter is usually removed on day two after the operation - the day on which most patients go home.

The urethral catheter is used for the short period immediately after surgery to ensure there is a good flow of urine and no unforeseen post operative problems.

After the urethral catheter is removed the suprapubic catheter helps to fully empty the bladder whilst the patient regains spontaneous normal voiding down the penis (urethra).

Only patients who have a perfect anastomosis are suitable for this (anastomosis is the reconnection, or join, between the bladder and urethra made after removing the bladder during a prostatectomy) technique. The join must be watertight. This is the case for over 80 per cent of patients.

For the majority of patients, the suprapubic catheter can be removed at 48 hours after surgery.

Alan Doherty, Clinical Director of the Birmingham Prostate Clinic, said: “This is a very significant step in the drive to improve the experience of a laparoscopic prostatectomy for patients.

“The one thing that bothers many patients more than any other aspect of the procedure is the catheter. They find the urethral catheter uncomfortable, often painful and dislike going home with it.

“This new drainage device (suprapubic catheter), combined with a high standard of anastomosis, provides a more effective, minimally-invasive and comfortable solution for patients immediately after a prostatectomy.

“This innovation is only possible because using keyhole surgery, we are able to achieve a much better anastomosis, or reconnection.”

A study published in the British Journal of Urology International (September 2008) reports patients using the new bladder drainage device had virtually none of the pain associated with a conventional urethral catheter.

Ashutosh Tewari MD, of Weill Cornell Medical College found catheter free bladder drainage also was associated with less discomfort while sleeping and walking and fewer episodes of bladder spasm.

“Urethral catheter-less robotic radical prostatectomy is feasible, with advantages of decreased penile shaft and tip pain and decreased patient discomfort and an earlier return of continence," the authors concluded. "In this pilot study there was no late-term complications such as bladder neck contracture.”