Purpose
Catheter-related bladder discomfort (CRBD) occurs in up to 63% of patients following robot-assisted radical prostatectomy (RARP). The optimal intra-operative anesthesia regime to prevent patients from CRBD is unknown.
Materials and Methods
A prospective cohort analysis was conducted. Patients with biopsy-proven prostate cancer selected for RARP were included between January 2017 and April 2020 from a high-volume prostate cancer center. Eight different treatment regimens were compared, ie a combination of general anesthesia and a transversus abdominis plane (TAP) block with either an additional dose of clonidine, or an additional dose of ketamine, or perivesical infiltrations (with 20ml ropivacaine, or periurethral infiltrations (with ropivacaine), or a dorsal penile nerve block (with 20ml ropivacaine). Multiple logistic regression and linear mixed models were used to analyze differences in CRBD and pain (0-10) at the post-operative recovery unit between the treatment protocols.
Results
391 patients were included. Patients with a combination TAP block, perivesical and periurethral block with ropivacaine had the lowest incidence of CRBD, clinically relevant and statistically significantly lower compared to our baseline protocol (TAP block only), ie 36% vs 70%, p=0.001. Overall, patients that were treated with periurethral and/or perivesical infiltrations reported a statistically significantly lower incidence of CRBD compared to patients who did not receive this local infiltration (46.5% vs 60.7%, p=0.001).
Conclusions
Perivesical and periurethral injections with ropivacaine have the potential to reduce the incidence of early postoperative CRBD by up to 49%. Further randomized studies are necessary to determine the optimal treatment regime to prevent early postoperative CRBD.