Robot-assisted Partial Nephrectomy: Is Routine Urinary Catheterization Still Mandatory in the Era of Enhanced Recovery?

OBJECTIVE: To assess the benefits and safety of noncatheterization during robot-assisted partial nephrectomy within an enhanced recovery protocol.

MATERIALS AND METHODS: A single-center retrospective comparative study was carried out of consecutive patients who underwent a robot-assisted partial nephrectomy between February 2015 and December 2017 within an early recovery program. The patients who received a urinary catheter were compared with those who did not in terms of postoperative complications, acute urinary retention rates, urinary tract infection rates, and lengths of hospital stay.

RESULTS: Of the 145 patients who followed an early recovery program after robot-assisted partial nephrectomy in the study period, 96 received a urinary catheter and 49 did not. There was no significant difference between these 2 groups in terms of the rates of acute urinary retention (3% vs 6%, respectively; P = .393), urinary tract infection (3% vs 2%; P = .707), postoperative complications (14% vs 18%; P = .445), or readmissions within 30 days (8% vs 6%; P = .636). However, patients who did not receive a catheter had shorter initial and total (including readmissions) lengths of hospital stay (respectively 2.16 days vs 2.56 days; P = .058, and 2.27 days vs 3.40 days; P <.001).

CONCLUSION: Our findings challenge the routine use of urinary catheterization during robot-assisted partial nephrectomies. Noncatheterization does not seem to increase the risk of postoperative urinary retention. Only catheterizing specific at-risk patients may prove beneficial.

Tremblais, B., Dominique, I., Terrier, J.-E., Ecochard, R., Hacquard, H., Ruffion, A., & Paparel, P. (2018). Robot-assisted partial nephrectomy: Is routine urinary catheterization still mandatory in the era of enhanced recovery? Urology. https://doi.org/10.1016/j.urology.2018.09.024