Omitting routine cystography after RARP: Analysis of complications and readmission rates in suprapubic and transurethral drained patients

OBJECTIVES: Robot-assisted radical prostatectomy (RARP) has become the therapy of choice for local treatment of prostate cancer. Postoperatively, urologists perform cystography before removing urinary catheters due to concerns about the integrity of the vesicourethral anastomosis. This study aims to evaluate the safety of waiving cystography before early catheter removal after RARP. METHODS: A total of 514 patients from two tertiary referral centers who underwent RARP were retrospectively included. Patients received postoperative urinary drainage by transurethral (TUC) or suprapubic catheter (SPC). During the first year, both centers performed routine cystography before removing TUC or SPC on postoperative day 5. In the following year, management changed and catheters were removed without cystography unless indicated by the surgeon. Demographic and perioperative data were analyzed. Postoperative complications and readmission rates were compared between standard cystography (StCG), no cystography (NCG), and selective cystography (SCG). RESULTS: Groups were comparable regarding demographic and oncological parameters. Analysis showed no significant difference regarding major complications and readmission rates between standard and no cystography (p = 0.155 and 0.998 respectively). Omitting routine cystography did not lead to inferior postoperative courses regardless of both urinary drainage used and tumor stage. Subgroup analysis showed an increase of major complications in SCG patients when compared with NCG (p = 0.003) while readmissions remained comparable (p = 0.554). CONCLUSION: Waiving routine cystography before early catheter removal after RARP appears to be safe and feasible regardless of urinary drainage. However, the selective cystogram at the surgeon's request still plays a role in monitoring patients with an elevated risk profile.