A urethral catheter is a thin tube which is inserted into the penis and up into the urethra in order to drain urine from the body. It is often uncomfortable, sometimes painful and patients dislike going home wearing the catheter.
At the Birmingham Prostate Clinic we have introduced a new approach, first developed in America by the urologist Mani Menon, which enables patients to go home catheter free.
It is based on using a drainage device inserted through the lower abdomen, called a suprapubic catheter, during surgery. This is far more comfortable than a urethral catheter.
It allows us to remove the urethral catheter within just 12 hours of surgery. The urethral catheter is needed for the immediate hours after surgery, to ensure there is a flow and voiding can continue.
The suprapubic catheter remains in place to relieve pressure while the patient regains control and the ability to void normally.
Only patients who have a perfect anastomosis (reconnection between the bladder and urethra after prostatectomy) are suitable for this technique. More than 80 per cent of patients will be suitable and able to leave hospital without a catheter.
For the majority of patients, the suprapubic catheter can then be removed at 48 hours post surgery.
This is very important because after a keyhole prostatectomy, patients normally go home on day two after surgery.
It makes an enormous difference to be able to discharge a patient free from a catheter, compared with leaving them with a catheter for a whole week.
This innovation is only possible because using the less invasive approach of keyhole surgery, we cause less disruption between the bladder and urethra when we remove prostate. We are able to achieve a much better reconnection, known as an anastomosis, between the urethra and bladder and this means patients regain control more quickly.
Catheter free discharge is a new and evolving development, but research from America suggests it is very effective and offers clear benefits for patients.
A study published in the British Journal of Urology International (September 2008) reports patients using the new bladder drainage device had virtually none of the pain associated with a conventional urethral catheter.
Ashutosh Tewari, M.D., of Weill Cornell Medical College found catheter free bladder drainage also was associated with less discomfort while sleeping and walking and fewer episodes of bladder spasm.
“Urethral catheter-less robotic radical prostatectomy is feasible, with advantages of decreased penile shaft and tip pain and decreased patient discomfort and an earlier return of continence,” the authors concluded. “In this pilot study there was no late-term complication such as bladder neck contracture.”
It must be emphasised that going home catheter free will not be possible for all patients. Some patients will not be ready to have their catheters removed at 12 and then at 48 hours and others will not be suitable for this approach.
But we believe that the catheter free approach will be suitable for around 80 per cent of prostatectomy patients.
So often, when we talk about developments in surgery, they are based on expensive, hi-tec solutions. Here, we have a relatively simple approach which has the potential to make an enormous difference to the experience of the thousands of patients who have prostate surgery every year.
This new approach is very important because it is based on a real understanding of the patient’s experience of a prostatectomy and is designed to improve that experience.
Alan Doherty is a Consultant Urologist at the Birmingham Prostate Clinic, a specialist prostate treatment center.