New catheter-less technique may ease pain and discomfort after
prostate cancer surgery
16 October 2008
An innovative and patient-friendly approach that eliminates the use
of a penile urinary catheter can ease the pain of recovery following
prostate cancer surgery. The new patentable technique, used in
conjunction with robotic prostatectomy (the surgical removal of the
prostate) eliminates the pain and discomfort associated with the
standard catheter. The new study is published in the British Journal
of Urology International.
"Robotic surgery offers better cosmetic benefits, reduced pain, early
continence, a high rate of sexual potency, and minimal blood loss, all
without sacrificing the success of cancer elimination," explains lead
researcher Dr Ashutosh Tewari, director of robotic prostatectomy and
outcomes research at NewYork-Presbyterian/Weill Cornell and the Ronald
P. Lynch Associate Professor of Urologic Oncology at Weill Cornell
"But, now, the new technique we are studying may further enhance the
comfort for our patients," says Dr Tewari.
The research team studied 50 patients — 30 implanted with the custom
designed device, and 20 who received the standard penile catheter. The
two groups were comparable in age, prostate specific antigen (PSA)
level, body mass index (BMI), the grade and stage of the cancer, length
of surgery, blood loss, and several other operative measures. The
results were positive.
The control group experienced penile pain and discomfort nine times
greater than the experimental group, and seven times greater discomfort
while walking and sleeping. There were no serious side effects observed
in either group.
"The results are very exciting because through this new technology,
we are able to continually improve on the robotic surgical option that
has already given men a high rate of continence and sexual function,"
says Dr Tewari.
Because robotic surgery has vastly improved recovery — allowing
patients to return home within one day of the procedure — patients will
often focus on the penile and urinary discomfort caused by the
catheter's implantation and following removal. The new approach,
developed by Dr. Tewari and his team, avoids implantation of an
irritating catheter through the penis' urethra — the tube connected to
the urinary bladder that allows for the passage of urine and seminal
fluid to the outside of the body.
The new approach re-routes urine directly from the bladder by way of
a narrow tube that exits through a small needle puncture below the gut,
and also serves to support the internal urinary structures as the
Past studies examining the advantages of avoiding catheter use have
indicated that they impart less risk for bacterial infection, reduce
discomfort, and reduce the need for re-catheterization.
"In the future, the new technique might also be used effectively for
non-robotic prostate removal," says Dr. Tewari.
However, Dr. Tewari says that not all patients may be a candidates
for this new option based on their body mass and amount of abdominal
fat, prostate size, or those who are taking blood thinning drugs or who
have a higher likelihood of bleeding.
These new findings build upon the groundbreaking work of Dr. Tewari,
and his collaborators in the Department of Urology at NewYork-Presbyterian/Weill
Cornell, to better improve the lifestyles of patients following prostate
removal, such as the reconstruction and sparing of nerves and muscles in
order to preserve urinary continence and sexual function. Dr. Tewari is
a leader in the field of robotic prostate surgery and has been involved
with over 2,500 surgeries to date.
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