It is well known that in addition to urethral catheter associated discomfort, there is an increased risk of ascending urethral infection, inflammation and stricture formation with urethral catheters.

Despite the emergence of a multitude of minimally invasive treatments for BPH, the traditional TURP or suprapubic prostatectomy is still commonly performed. Open prostatectomy offers the advantage of a lower re-treatment rate and more complete removal of the prostate adenoma under direct vision, while it avoids the risk of TUR syndrome.

The post-operative morbidity of the suprapubic prostatectomy includes hemorrhage, clot retention, incontinence, urethral or bladder neck stricture and UTI. Some are related to the use of urethral catheters, such a severe bladder irritation, ascending UTI or epididymoorchitis and urethral stricture formation.

A recent report examines the use of a novel catheter, instead of the traditional urethral catheter, for the post-operative urinary drainage after a suprapubic prostatectomy. The study, by H. Djaladat and colleagues from Tehran Iran, is published in the June 2006 issue of the Journal of Urology.

A total of 146 patients underwent suprapubic prostatectomy for refractory lower urinary tract symptoms or urinary retention. Of the patients, 96 were treated with a novel technique without a urethral catheter but with a specially configured 24 F 3-way suprapubic tube. The tube was placed suprapubically and the end drainage holes were tied off with a silk suture. The balloon was filled within the prostatic fossa after adenoma enucleation and two additional drainage holes were made in the side of the catheter that lies within the bladder to allow for urinary drainage and irrigation. The tube was fixed at the dome of the bladder using a purse string suture to prevent migration. A closed suction drain was placed in the space of Reitzius. Fluid was removed slowly from the novel catheter balloon as the urine cleared. The balloon was completely emptied between 24 and 36 hours and the catheter was removed in 5 to 7 days. The mean balloon fluid volume was 29.5 cc. Post-operative indices were compared between the group using the novel catheter and a group of 48 patients using traditional urethral and suprapubic catheters.

Analysis of the results showed that there was no report of clot retention or significant irritation in the novel catheter group, while 22 (44%) and 19 (38%) in the control group had significant irritative symptoms and at least 1 episode of clot retention. The post-operative decrease in hemoglobin was 0.8 mg/dl in the novel group and 1.9 mg/dl in the control group. There were no reports of epididymoorchitis with the novel catheter but this was identified in 4 (8%) in the control group (p

< 0.05). In follow-up at 6 months, all patients underwent cystoscopy. The incidence of membranous urethral strictures was 4.1% in the novel catheter group and 14% in the control group. Four more patients had penile urethral stricture and 3 had bladder neck contractures in the control group. Early incontinence (1 week post-operatively) was also reported in 4% of patients with the novel catheter but in 62% of the control group. It did improve in 95% of patients.

This study suggests improved immediate post-operative morbidity with the use of the novel urinary catheter for use in suprapubic prostatectomy with a decrease in the incidence of urethral stricture disease.

By Michael J. Metro, MD