Impact of Prolonged Catheterization for Vesicourethral Leakage on Continence and Quality of Life After Robotic Prostatectomy

TL;DR

This study finds that extended catheter use due to leakage after prostate surgery does not harm long-term urinary control or quality of life.

Contribution

The study is the first to show that prolonged catheterization after prostate surgery does not negatively impact continence or quality of life.

Findings

Continence recovery was similar between prolonged and standard catheter groups at 1, 6, and 12 months.

Quality of life outcomes were comparable despite prolonged catheterization.

Prostate specimen weight and intraoperative leakage predicted prolonged catheterization.

Abstract

Introduction: To determine whether prolonged urinary catheterization due to vesicourethral anastomotic leakage (VAL) after robot-assisted radical prostatectomy (RARP) impacts urinary continence recovery and quality of life (QOL).

Methods: We retrospectively analyzed 360 patients who underwent transperitoneal RARP at a single institution from January 2022 to December 2024. All patients underwent cystography on postoperative day 6 or 7. Those with VAL requiring extended catheterization were compared with patients undergoing standard removal. Continence was assessed using Question 5 of the Expanded Prostate Cancer Index Composite (EPIC), and QOL was measured with the Functional Assessment of Cancer Therapy-General (FACT-G), FACT-Prostate (FACT-P), and the EPIC urinary subscale. Outcomes were evaluated up to 24 months postoperatively.

Results: VAL was detected in 36 patients (10.0%). Continence recovery did not differ significantly between the prolonged and standard catheter groups at 1, 6, or 12 months (63%, 89%, 92% vs. 54%, 85%, 93%, respectively). QOL outcomes were also comparable, although preoperative EPIC scores were lower in the prolonged catheter group. Multivariate analysis identified greater prostate specimen weight (p = 0.049) and intraoperative leakage (p = 0.002) as independent predictors of prolonged catheterization.

Conclusions: Prolonged urinary catheterization due to VAL after RARP does not adversely affect long-term urinary continence recovery or urinary-related QOL.

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