Randomized Clinical Trial
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Urol. Jul 24, 2017; 6(2): 44-50
Published online Jul 24, 2017. doi: 10.5410/wjcu.v6.i2.44
Combined urethral and suprapubic catheter drainage improves post operative management after open simple prostatectomy without bladder irrigation
Anselm Okwudili Obi
Anselm Okwudili Obi, Department of Surgery, Federal Teaching Hospital, Abakaliki 48000, Ebonyi State, Nigeria
Anselm Okwudili Obi, Department of Surgery, Ebonyi State University, Abakaliki 48001, Ebonyi State, Nigeria
Author contributions: This is a sole authorship.
Institutional review board statement: The study design was reviewed and approved by the Ebonyi state university Research Ethics Committee.
Informed consent statement: All participants gave their written informed consent before inclusion in the study.
Conflict-of-interest statement: I have no conflicts of interest to declare.
Data sharing statement: The author on request will provide the raw data on which the study results were derived.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Anselm Okwudili Obi, FWACS, FICS, Department of Surgery, Federal Teaching Hospital, PMB 102, Abakaliki 48000, Ebonyi State, Nigeria. draoobi@yahoo.com
Telephone: +234-80-33464195
Received: December 29, 2016
Peer-review started: December 31, 2016
First decision: January 26, 2017
Revised: March 9, 2017
Accepted: April 16, 2017
Article in press: April 17, 2017
Published online: July 24, 2017
Processing time: 203 Days and 19.4 Hours
Abstract
AIM

To compare outcomes after open simple prostatectomy without bladder irrigation, in subjects drained by combined 2-way urethral catheter and suprapubic catheter (SPC) vs those drained by 2-way urethral catheter only.

METHODS

A total of 84 participants undergoing Freyer’s simple prostatectomy over an 18-mo period were randomized into 2 groups (n = 42). Subjects in group 1 were managed with 2-way urethral catheter and in situ 2-way SPC while subjects in group 2 had a 2-way urethral catheter drainage only. In group 1 subjects, the SPC was spigotted and only used for drainage if there was clot retention. The primary outcomes were number of clot retention episodes, and number of clot retention episodes requiring bladder syringe evacuation. Other secondary outcomes evaluated were blood loss, requirement of extra analgesics, duration of surgery, hospital stay and presence or absence of post-op complications.

RESULTS

The mean age in the groups was 65.7 (± 7.6) in group 1 vs 64.8 (± 6.8) in group 2. The groups were similar with respect to age, prostate specific antigen, prostate volume, blood loss, duration of surgery, blood transfusion and overall complication rate. However statistically significant differences were observed in clot retention episodes between group 1 and 2: 0.8 (± 1.5) vs 3.5 (± 4.4), P < 0.000, clot retention episodes requiring evacuation with bladder syringe 0.4 (± 0.9) vs 2.6 (± 3.8), P = 0.001, requirement of extra analgesics 0.4 (± 0.5) vs 4.0 (± 1.5), P < 0.000 and duration of admission 8.6 d (± 1.2) vs 7.3 d (± 0.6), P < 0.000.

CONCLUSION

Subjects drained with a combination of urethral and SPCs have fewer clot retention episodes and reduced requirement of extra analgesics but slightly longer hospital stay.

Keywords: Open suprapubic prostatectomy; Catheter drainage; Clot retention; Post operative outcome; Benign prostatic hyperplasia

Core tip: Most urologists will agree that the most worrisome post operative challenge after open suprapubic prostatectomy (OSP) is post operative haemorrhage and the attendant clot retention. This paper seeks to show that the use of a combination of suprapubic and urethral catheters as opposed to using only a urethral catheter to drain the bladder after OSP is associated with reduced clot retention episodes, reduced clot retention episodes requiring bladder syringe evacuation and therefore less post operative morbidity.