Early cystography before catheter removal after robot-assisted radical prostatectomy: A single-center experience

Purpose: This study aimed to evaluate early cystography after robot-assisted radical prostatectomy (RARP) in prostate cancer patients to expedite discharge, examine urinary leakage incidence, and assess related factors. Materials and methods: We retrospectively reviewed records from January 2017 to December 2022 for 316 RARP patients at Chi Mei Foundation Hospital. Patients were grouped by postoperative day (POD) of cystography (≤3 vs >3 days). Data collected included preoperative characteristics, hospitalization, catheter duration, leakage, and complications. Results: Of 316 patients, 142 (44.9%) had cystography on POD ≤3, while 174 (55.1%) had it on POD >3. The early group had shorter catheterization (3 vs 6 days) and hospitalization (4 vs 7 days) durations ( P < 0.0001). Leakage rates were similar between groups (14.08% vs 12.07%), though acute urine retention (9.15% vs 3.45%, P = 0.0338) and Foley catheter reinsertion (13.38% vs 5.17%, P = 0.0106) were significantly higher in the early group. Prolonged catheterization and hospitalization were associated with postoperative leakage ( P < 0.0001). Patients with transurethral resection of the prostate and bladder neck reconstruction history or increased blood loss showed higher leakage risk ( P = 0.0309 and P = 0.0221, respectively). Conclusion: Early cystography can reduce hospitalization and catheter duration after RARP without increasing leakage risk, though careful monitoring is advised due to higher acute urine retention rates with early catheter removal. Transurethral resection of the prostate with bladder neck reconstruction history and increased blood loss warrant additional caution.