Comparison of Early Clinical Outcomes in Early Versus Delayed Urethral Catheter Removal Following Open Simple Retropubic Prostatectomy.

Abstract

Background: Despite the clear advantages of endoscopic management for treating benign prostatic hyperplasia, open simple prostatectomy (OSP) is still relevant in developing nations like Nigeria. Open simple retropubic prostatectomy is commonly used because it gives direct access to the prostate with improved achievement of haemostasis, early recovery, and less risk of bladder neck stenosis. Urethral catheter (UC) is traditionally used following prostatectomy, not only for drainage of the urinary bladder but also for stenting, and it sometimes results in haemostasis. There is no consensus on the duration of urethral catheterisation, which varies between surgeons and institutions.

Objectives: We aimed to compare the early clinical outcomes following 3rd day (early) versus 6th day (delayed) UC removal following open simple retropubic prostatectomy.

Materials and methods: The study was a prospective, hospital-based, randomised comparative study. Patients were randomised to groups A (3rd day post-operative UC removal) and B (6th day post-operative UC removal) using simple randomisation.

Data analysis and result presentation: Data were collected with the aid of a purposefully designed proforma and entered into the Statistical Package for Social Sciences version 21 for analysis. Tables and charts were used to represent descriptive statistics. Chi-square and Student t test were used to test significant differences in categorical and continuous variables, respectively. P value of <0.05 was considered statistically significant.

Results: Fifty patients were recruited into the study. Patients were randomised into group A (third day catheter removal) and group B (sixth day catheter removal), with 25 patients in each arm of the study. The mean age was 70.92 ± 13.98 years (range 50-81 years). No patient required recatheterisation following 3rd and 6th day of catheter removal. The average urethral pain scores during the first void after removal of the UC on the 3rd and 6th postoperative days were 2.52 ± 2.00 and 1.04 ± 1.00, respectively; P value was <0.001. The urethral pain score reduced significantly in groups A and B to 1.00 ± 1.00 and 0.32 ± 0.00, respectively, within 24 h of the removal of the catheter with P value of 0.001. The average lengths of hospital stay were 4.20 ± 4.00 and 7.24 ± 7.00 for patients in group A and B, respectively, with P value < 0.001.

Conclusion: OSP can be brought closer to the "Gold standard" (transurethral resection of the prostate) by early catheter removal and short hospital stay with satisfactory early post-operative outcomes. The initial urethral pain improves significantly within 24 h.