Early catheter removal and postoperative status of bladder outflow after retropubic radical prostatectomy

Abstract

前立腺全摘術後35例に対し, 6日目または7日目に膀胱造影施行し, 漏れがなければ尿道カテーテルを抜去した.そして, Uroflowmetryをカテーテル抜去直後と外来follow時(4～20ヵ月)に施行した.その結果, 1)1例を除き尿道カテーテルを早期抜去できたが, 抜去直後3例に尿閉を認め尿道カテーテルを再留置した.2)尿失禁に関してはexcellent(pad必要なし)が25例(71.4%), good(padが1枚以下)が7例(20%)であった.3)抜去直後uroflowmetryのmaximum flow nomogramでは12例に排尿困難を認めたが, 外来follow時では8例に減少していた.しかし, そのうち3例に吻合部狭窄, 1例に尿道狭窄が認められた.以上, これらのことからも, 尿道カテーテル早期抜去は安全に施行できると考えられたが, 抜去直後に排尿困難や尿閉を来す症例もあり, おそらく吻合部の浮腫が原因と考えられた.一方, 術後しばらくしてから排尿困難を訴える場合は吻合部狭窄や尿道狭窄を念頭に置く必要があると思われた

Cystography was performed on 35 patients 6 to 7 days after retropubic radical prostatectomy (RRP), to determine the feasibility of early removal of the urinary catheter. The urethral catheter was removed the same day if no extravasation was evident on cystography. Uroflowmetry was also performed both immediately after early catheter removal and at follow-up 4 to 20 months later. The urethral catheter could be removed on postoperative day 6 or 7 from all but one patient. Three patients developed acute urinary retention after catheter removal, requiring reinsertion of a Foly catheter. During a mean follow-up of 8.3 months (range 4 to 20 months), 25 patients (71.4%) reported excellent continence (requiring no pad) and seven patients (20%) good continence (requiring a single pad). Immediately after early catheter removal, 12 patients (34%) showed obstruction on a maximum flow nomogram. The number of patients with obstruction decreased to eight during follow-up, three of whom suffered anastomotic stricture and one anterior urethral stricture, all of which required urethrotomy. Our results show that early catheter removal can be accomplished safely, although some patients may have difficulty with urination or develop acute urinary retention immediately after catheter removal, probably due to anastomotic edema. On the other hand, if the patients develop difficulty in urination some time after the operation, the possibility of anastomotic or urethral stricture should be considered. Therefore we recommend uroflowmetry within one year after RRP to identify anastomotic or urethral stricture.