“No catheter” radical prostatectomy … Just how viable is this really?

According to a media release issued by the University of Cincinnati Health Center last Thursday, a urologist at that center is now offering patients robot-assisted laparoscopic prostatectomies (RALPs) without transurethral catheterization post-surgery. They describe this as a “no catheterization” technique.

Now let us be very clear that the operation as described in the media release is certainly possible. Instead of using a transurethral catheter, the procedure actually allows for direct drainage of urine from the bladder post-surgery via a tube inserted into the bladder through a small incision above the pubic bone. This technique is well known as “suprapubic catheterization” and is used regularly for men who undergo high-intensity focused ultrasound (HIFU) as a first-line treatment for prostate cancer.

In other words, the patients still have to be catheterized. This is just being done differently. The media release does not specify how long this suprapubic catheter is left in place, but in a set of brief video clips associated with the media release it is made clear that the patient must wear this suprapubic catheter for about 7 days. Thus, to call this technique a “no catheter” technique is quite simply untruthful.

The media release claims a variety of benefits resulting from this form of catheterization:

  • “[S]pares the patient of the irritation of a penile catheter during recovery”
  • “[A]llows for early bladder training”
  • “Patients experience less pain with this technique”
  • “[O]utcomes are no different when the surgery is performed at experienced medical centers”

It also states that, “Studies have shown that almost 80 percent of patients are severely bothered by the presence of a catheter after surgery.”

 Regrettably, however, no data are provided in support of these claims, nor is there a specific reference to any published data on outcomes after the use of this technique. It seems obvious to us that a large percentage of men are “bothered” by having to put up with post-surgical catheterization of any type … but it is far from clear why suprapubic catheterization would be significantly less bothersome for most men than transurethral catheterization. Again, in the video clips, a claim is made that “studies” support the effectiveness and safety of this form of radical prostatectomy, but there is no reference to any published data.

The media release also completely ignores one of the major reasons for transurethral catheterization. Transurethral catheterization helps to stabilize the surgical reattachment of the urethra to the bladder neck for a period of time immediately following surgery. It is less than clear to us what the potential outcome of such lack of stabilization might be. Is Dr. Patil using some form of stent to stabilize this anastomosis instead? (Note that HIFU as a first-line treatment for prostate cancer does not require the urethra to be cut away from the bladder neck and then reattached, which is a necessary component of all radical prostatectomies.)

The “New” Prostate Cancer InfoLink is frankly rather disturbed by this type of media promotion of a specific surgical technique without the support of detailed, published data to support the claims being made.

4 Responses

  1. For what it’s worth, I also had a suprapubic catheter after my focal cryotherapy but that was primarily because I’d had major problems with a penile catheter after a biopsy. However, in the case of RP, I can certainly see the value of a catheter as a stabilizer for the urethra. It sounds to me like this is just a gimmick more than a real break-through.

  2. It takes several years and millions of dollars to get through the approval process for new drugs, but some surgeon in Cincinnati can just go ahead with an unproven technique without any oversight at all. Some of these people seem to think they are infallible. I can personally testify that some of them are not.

  3. This procedure is gaining popularity. Having had a RP 2 years ago and suffered greatly with urinary difficulties the idea of maintaining bladder control and avoiding trauma caused by a transurethral catheter seems great. There seems to be no higher adverse outcomes. I would like to see more surgeons develop their skills to meet patients’ needs.

  4. Dear Stanley:

    (1) What data do you have to confirm that this technique is “gaining in popularity” and among whom — surgeons or a subset of patients?

    (2) There is no reason that I am aware of why a transurethral catheter would “cause trauma” when properly utilized by an experienced surgeon. (And I am by no means suggesting that you didn’t have problems, but they could have occurred for all sorts of reasons that were not, in fact, cause by the catheter.)

    (3) We are still waiting to see any data that confirm the claims of this media release that was no issued a while ago.

    Any form of catheterization is nnoying for the majority of surgical patients. And for the vast majority of them it is a temporary irritation, whether it is done transurethrally or suprapubically.

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