機器人輔助根治性攝護腺切除術後導管拔除前的早期膀胱造影

鄭宛妤¹、謝佳駤²、曾文歆^2,3、林才揚²、蘇家震²、李高漢²、劉建良⁴、黃冠華²、邱文祥⁵

¹台南永康奇美醫院 一般科，²台南永康奇美醫院 外科部 泌尿科；³國立中山大學生物醫學研究所；⁴台南永康奇美醫院 外科部 泌尿腫瘤科；⁵新光醫院 外科部 泌尿科

Early cystography before catheter removal after robot assisted radical prostatectomy Wan-Yu Cheng ¹、Chia-Chih Hsieh²、Wen-Hsin Tseng^2,3、Chye-Yang Lim²、Chia-Cheng Su²、

Kau-Han Lee²、Chien-Liang Liu⁴、Steven K. Huang²、Allen W.Chiu⁵

¹ Post graduate year (PGY) training, Chi Mei Medical Center, Tainan, Taiwan;

² Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan;

³Institute of Biomedical Science, National Sun Yat-Sen University, Kaohsiung, Taiwan;

⁴Division of Uro-Oncology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan;

⁵Department of Urology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan

Purpose: A cystography is often performed on postoperative day (POD) 7 or later after a robot-assisted radical prostatectomy (RARP) for clinically prostate cancer (PCa). However, in this study, we have performed cystography on POD 2-4 to investigate whether earlier cystography can expedite patient discharge and catheter removal, and to compare the incidence of leakage as well as its associated factors.

Materials and Methods: We conducted a retrospective review of RARP in 316 patients of Chi Mei Foundation Hospital between January 2017 and December 2022. Grouping was based on postoperative day for cystography (Group A: within 4 days vs Group B: more than 5 days). Preoperative characteristics, hospitalization days, catheter indwelling days, postoperative leakage, and perioperative complications were also assessed.

Results: In total, 231 (73.1%) and 85 (26.9%) patients underwent POD ≤ 4 (Group A) and POD > 5 (Group B) cystography, respectively. The median hospitalization days (5 vs. 7 days) and catheter indwelling days (4 vs. 7 days) were significantly shorter for early cystography group (p <0.0001). There was no significant difference in postoperative leakage (12.99% vs. 12.94%) between groups A and B. Acute urine retention was significantly more frequent in Group A (8.23% vs. 0%, p = 0.0064), and there was a trend toward more frequent catheter re-insertions in Group A (7.39% vs. 1.18%, p = 0.0510). Among the patients, 44 (13.92%) experienced leakage, while 272 (86.08%) did not. The median hospitalization days (7.5 vs. 6 days, p = 0.0009) and catheter indwelling days (7 vs. 4 days, p < 0.0001) were significantly longer in the leakage group compared to the no leakage group. Furthermore, no significant differences in complication rates between the two groups (2.44% vs. 2.55%). Factors such as prostate size, stage > T2, margin invasion, console time, and blood loss showed no statistically significant differences between the two groups. However, A history of transurethral resection of the prostate (TURP) was significantly associated with an increased risk of postoperative leakage (25% vs. 11.76%, p = 0.0175).

Conclusion: Early cystography after RARP is feasible and safe and can reduce hospitalization and catheter indwelling days without increasing the risk of leakage. However, it is essential to be cautious regarding the higher incidence of acute urine retention associated with early catheter removal. In addition, patients with a history of TURP should be carefully monitored for leakage and may require delayed cystography. This information can inform decision-making regarding the timing of cystography and postoperative care protocols for RARP patients.