Intraoperative Strategies to Reduce Catheter-Related Bladder Discomfort in the Early Postoperative Period after Robot-Assisted Radical Prostatectomy.

Abstract

CONCLUSIONS

Perivesical and periurethral injections with ropivacaine have the potential to reduce the incidence of early postoperative CRBD by up to 49%. Further randomized studies are necessary to determine the optimal treatment regime to prevent early postoperative CRBD.

PURPOSE

Catheter-related bladder discomfort (CRBD) occurs in up to 63% of patients following robot-assisted radical prostatectomy (RARP). The optimal intra-operative anesthesia regime to prevent patients from CRBD is unknown.

RESULTS

391 patients were included. Patients with a combination TAP block, perivesical and periurethral block with ropivacaine had the lowest incidence of CRBD, clinically relevant and statistically significantly lower compared to our baseline protocol (TAP block only), ie 36% vs 70%, p=0.001. Overall, patients that were treated with periurethral and/or perivesical infiltrations reported a statistically significantly lower incidence of CRBD compared to patients who did not receive this local infiltration (46.5% vs 60.7%, p=0.001).

MATERIALS AND METHODS

A prospective cohort analysis was conducted. Patients with biopsy-proven prostate cancer selected for RARP were included between January 2017 and April 2020 from a high-volume prostate cancer center. Eight different treatment regimens were compared, ie a combination of general anesthesia and a transversus abdominis plane (TAP) block with either an additional dose of clonidine, or an additional dose of ketamine, or perivesical infiltrations (with 20ml ropivacaine, or periurethral infiltrations (with ropivacaine), or a dorsal penile nerve block (with 20ml ropivacaine). Multiple logistic regression and linear mixed models were used to analyze differences in CRBD and pain (0-10) at the post-operative recovery unit between the treatment protocols.

More about this publication

The Journal of urology
  • Pages 101097JU0000000000001645
  • Publication date 19-02-2021

This site uses cookies

This website uses cookies to ensure you get the best experience on our website.