機械手臂輔助攝護腺切除手術後尿管延遲移除之探討

江長和¹、黃子豪 ^1,2,3、陳昱光¹、張延驊^1,2,3、盧星華^1,2,3、鍾孝仁^1,2,3、

黃逸修^1,2,3、林子平^1,2,3、林志杰^1,2,3、黃奕燊^1,2,3、陳威任^1,2,3、林冠榮^1,2,3、

黃志賢^1,2,3

1台北榮民總醫院泌尿部

2國立陽明交通大學醫學院泌尿學科及3書田泌尿科學研究中心

Delayed Foley catheter removal after robotic assisted laparoscopic prostatectomy

Chang-Ho Chiang¹, Tzu-Hao Huang^1,2, Yu- Kuang Chen¹, Yen-Hwa Chang^1,2,Shing-Hwa Lu^1,2,Hsiao-Jen Chung^1,2,Yi-Hsiu Huang^1,2,Tzu-Ping Lin^1,2,

Shing-Hwa Lu^1,2,Chih-Chieh Lin ^1,2,I-Shen Huang^1,2,Wei-Jen Chen^1,2,

Kuan-Jung Lin^1,2,William J. Huang^1,2

¹Department of Urology, Taipei Veterans General Hospital, Taiwan

²Department of Urology, College of Medicine, and ³Shu-Tien Urological Science Research Center, National Yang-Ming Chiao Tung University, Taipei, Taiwan

Purpose:

 Robotic assisted laparoscopic prostatectomy (RALP) has been widely adopted worldwide for more than 10 years. Foley catheter is important for maintaining the patency of vesicourethral anastomosis after RALP. Early catheter removal has been reported in some prior series, which showed to be safe and offered a better quality of life during the postoperative recovery.. This study aimed to evaluate the incidence of delayed Foley catheter removal after RALP and its associated risk factors by using a prospectively collected cohort in a high-volume medical center.

Materials and Methods:

From January 2014 to December 2019, total 735 patients underwent RALP at Taipei Veterans General Hospital. A cystography is usually performed within five days after RALP, and Foley catheter is removed if there is no significant leakage. Demographic data, perioperative factors including Foley catheter indwelling duration and vesicourethral anastomosis leakage were collected for analysis. Patients without postoperative cystography were excluded. In the current study, delayed Foley catheter removal was defined as Foley catheter indwelling duration longer than 7 days. We compared the difference between patients who had delayed Foley catheter removal after RALP and those who did not by multivariate logistic regression.

Results

Of 630 enrolled patients, Foley catheter was removed on a median of postoperative day 4. Eighty-nine patients (14.1%) had delayed Foley catheter removal after RALP and 541 (85.9%) did not. In our cohort, older age, higher preoperative PSA, prior history of transurethral resection of prostate, more advanced tumor pathological stage, longer console time, requirement for bladder neck reconstruction, use of suspension stitch during operation, presence of post-operative anastomosis leakage and less experienced surgeons were associated with delayed Foley catheter removal after RALP. However, on multivariate analysis, only postoperative anastomosis leakage (OR=8.51, 95% CI: 4.85-14.94, p<0.001) and bladder neck reconstruction (OR=3.03, 95%CI: 1.66-5.54, p<0.001) were significantly associated with delayed Foley catheter removal, while high-volume surgeon is associated with a lower odd (OR=0.28, 95%CI: 0.16-0.48, p<0.001) of delayed Foley catheter removal.

Conclusions

Our data showed that the incidence of delayed Foley catheter removal was 14.1%. In our cohort, patients undergoing RALP by high-volume surgeons are associated with a lower rate of delayed catheter removal. This suggested that approaches to avoid postoperative anastomosis leakage and accumulation of experience are crucial for shortening the duration of Foley catheter indwelling after RALP.