© 2008 THE AUTHORS 1000 JOURNAL COMPILATION © 2 0 0 8 B J U I N T E R N A T I O N A L | 1 0 2 , 1 0 0 0 – 1 0 0 4 | doi:10.1111/j.1464-410X.2008.07875.x 2008 The Authors. Journal compilation 2008 BJU International Original Article CATHETER-LESS ROBOTIC RP USING A ANASTOMOTIC SPLINT AND URINARY DIVERSION DEVICE TEWARI et al. Catheter-less robotic radical prostatectomy using a custom-made synchronous anastomotic splint and vesical urinary diversion device: report of the initial series and perioperative outcomes Ashutosh Tewari, Sandhya Rao and Anil Mandhani Department of Urology, The New York-Presbyterian Hospital, Weill Medical College of Cornell University, New York, NY, USA Accepted for publication 10 April 2008 which provided a small anastomotic splint, multiple holes for drainage and the ability to retract the splint to give a voiding trial before removing the drainage device. Group 2 was a control group of 20 patients who had standard urethral catheterization with an 18 F Silastic Foley catheter. Demographic, intraoperative and outcome data were measured and analysed. Urethral symptoms were recorded using a specially developed questionnaire. RESULTS The two groups were comparable in terms of age, serum prostate specific antigen level, body mass index, Gleason scores, tumour stage, operative duration, amount of bleeding, console times, anastomotic leakage and postoperative retention rates. The study group had significantly less penile shaft or tip pain and discomfort during walking or sleeping. No patient in either group had haematuria or clot retention requiring irrigation. CONCLUSION Urethral catheter-less robotic radical prostatectomy is feasible. The advantages are decreased penile shaft and tip pain, and decreased patient discomfort and an earlier return of continence. KEYWORDS catheter, suprapubic, urethral, robotic prostatectomy Study Type – Therapy (case control) Level of Evidence 3b OBJECTIVE To study the feasibility of avoiding a urethral catheter after robotic radical prostatectomy by using suprapubic diversion with a urethral splint, as urethral catheterization is often a source of major discomfort and pain to the patient, and can cause more concern to the patient than the procedure; we present the outcomes of a pilot study. PATIENTS AND METHODS This pilot study involved 30 patients; in group 1 (the study group of 10 patients) we used a custom-made suprapubic catheter INTRODUCTION Robotic radical prostatectomy (RP) has emerged as a common surgical procedure in the management of clinically localized prostate cancer. Patients choosing this procedure are usually driven by its cosmetic benefits, earlier continence, shorter recovery time and minimal blood loss [1–3]. Despite the smaller incisions, early ambulation and shorter hospital stay, a few patients, especially younger ones, continue to complain about the urethral Foley catheter. They experience urethral discomfort, penile tip pain, and meatal encrustation and irritation due to the indwelling catheter. Recovery is essentially uneventful and smooth, leading patients to focus on the catheter and complain that they wish that there was no need for a urethral catheter. With this background we explored the idea of avoiding a urethral catheter without compromising the time-tested principle of splinting the anastomosis in the initial few days after robotic RP. This quest was guided both by patient demand and the potential for complications which can occur after urethral catheterization, e.g. urethral stricture, meatal stenosis, urethritis and ascending urethral bacterial colonization. The catheter after RP splints the anastomosis and prevents the formation of cross synechia, and drains the bladder. We sought alternatives for achieving these two goals while obviating the need for a tube exiting through the penis. One such alternative was a urinary drainage tube using the suprapubic route. However, this would not splint the anastomosis, thus increasing the risk of bladder neck contracture. Therefore we sought a custom-made tube which would not only drain the bladder but also splint the anastomosis. After experimentation with a few initial prototypes, we settled on a custom-made catheter which provided a small anastomotic splint, two balloons to prevent either upward or downward migration, multiple holes for drainage and the ability to retract the splint to give a voiding trial before removing the drainage device. The aims of our study were: (i) to develop a technique of urethral catheter-less robotic RP BJUI BJU INTERNATIONAL