The use of a catheter for urinary drainage post robotic assisted radical prostatectomy (RARP) is critical to allow urinary diversion and preservation of the vesicourethral anastomosis. Traditionally, this purpose is served by placement of an indwelling urethral catheter. However, urethral catheters can cause postoperative discomfort, penile pain and bladder spasms, and results in significant functional limitations. The aim of this project is to assess patient experience with a suprapubic catheter (SPC) versus indwelling urethral catheter (UC) post RARP.

This is a prospective cohort study of patients undergoing RARP from August to December 2024 at two private healthcare facilities in Australia. Patients in group 1 received SPC and group 2 received UC post RARP according to surgeon practice. At the time of trial of void (TOV), patients completed a questionnaire addressing pain associated with their catheter using the Visual Analogue Scale (VAS), as well as number of consultations or use of pharmacological agents to manage catheter-associated issues. Impact of the catheter on social activities was also assessed. Early continence was assessed using pad weights over 24-hour period at 1 and 6 weeks post TOV, and early urethral stricture rates assessed at 3 months.

71 patients were recruited into the study with 41 patients in group 1 and 30 patients in group 2. Group 1 had a lower VAS score compared to group 2 (1.70 vs 3.53, p=0.001), lower rates of reported bothersome symptoms (39% vs 67%, p=0.035) and less impact on social activities (56% vs 23% reported no impact on social activity, p=0.014). The rate of pharmacological use was lower in group 1 (29% vs 40%, p=0.345), however rate of additional consults required to manage SPC was higher (29% vs 27%, p=0.950) although these results did not reach statistical significance. Group 1 had less incontinence over 24-hour hours at 1 week (124g vs 146g, p=0.171) and 6 weeks (43g vs 92g, p=0.139) post TOV compared to group 2. Urethral stricture rate at 3 months was 0 for group 1 vs 7% for group 2 (p=0.094).

These preliminary results support SPC as a feasible alternative to UC post RARP for improved patient experience and early incontinence rates with no compromise on urethral stricture rates. Larger cohort randomized studies are required to confirm these findings.