Abstract：
To assess the clinical value of routine pelvic drain (PD) placement and early removal of urethral catheter (UC) in patients undergoing robot-assisted radical prostatectomy (RARP), as perioperative management such as the necessity of PD or optimal timing for UC removal remains highly variable.
Multiple databases were searched for articles published before March 2022 according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement. Studies were deemed eligible if they investigated the differential rate of postoperative complications between patients with/without routine PD placement and with/without early UC removal, defined as UC removal at 2-4 days after RARP.
Overall, eight studies comprising 5112 patients were eligible for the analysis of PD placement, and six studies comprising 2598 patients were eligible for the analysis of UC removal. There were no differences in the rate of any complications (pooled odds ratio [OR] 0.89, 95% confidence interval [CI] 0.78-1.00), severe complications (Clavien-Dindo Grade ≥III; pooled OR 0.95, 95% CI 0.54-1.69), all and/or symptomatic lymphocele (pooled OR 0.82, 95% CI 0.50-1.33; and pooled OR 0.58, 95% CI 0.26-1.29, respectively) between patients with or without routine PD placement. Furthermore, avoiding PD placement decreased the rate of postoperative ileus (pooled OR 0.70, 95% CI 0.51-0.91). Early removal of UC resulted in an increased likelihood of urinary retention (OR 6.21, 95% CI 3.54-10.9) in retrospective, but not in prospective studies. There were no differences in anastomosis leakage and early continence rates between patients with or those without early removal of UC.
There is no benefit for routine PD placement after standard RARP in the published articles. Early removal of UC seems possible with the caveat of the increased risk of urinary retention, while the effect on medium-term continence is still unclear. These data may help guide the standardisation of postoperative procedures by avoiding unnecessary interventions, thereby reducing potential complications and associated costs.
Multiple databases were searched for articles published before March 2022 according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement. Studies were deemed eligible if they investigated the differential rate of postoperative complications between patients with/without routine PD placement and with/without early UC removal, defined as UC removal at 2-4 days after RARP.
Overall, eight studies comprising 5112 patients were eligible for the analysis of PD placement, and six studies comprising 2598 patients were eligible for the analysis of UC removal. There were no differences in the rate of any complications (pooled odds ratio [OR] 0.89, 95% confidence interval [CI] 0.78-1.00), severe complications (Clavien-Dindo Grade ≥III; pooled OR 0.95, 95% CI 0.54-1.69), all and/or symptomatic lymphocele (pooled OR 0.82, 95% CI 0.50-1.33; and pooled OR 0.58, 95% CI 0.26-1.29, respectively) between patients with or without routine PD placement. Furthermore, avoiding PD placement decreased the rate of postoperative ileus (pooled OR 0.70, 95% CI 0.51-0.91). Early removal of UC resulted in an increased likelihood of urinary retention (OR 6.21, 95% CI 3.54-10.9) in retrospective, but not in prospective studies. There were no differences in anastomosis leakage and early continence rates between patients with or those without early removal of UC.
There is no benefit for routine PD placement after standard RARP in the published articles. Early removal of UC seems possible with the caveat of the increased risk of urinary retention, while the effect on medium-term continence is still unclear. These data may help guide the standardisation of postoperative procedures by avoiding unnecessary interventions, thereby reducing potential complications and associated costs.
摘要：
目的：评估机器人辅助前列腺癌根治术（RARP）患者常规盆腔引流（PD）放置和早期拔除尿道导管（UC）的临床价值。因为围手术期管理，如PD的必要性或UC切除的最佳时机仍然存在很大差异。
方法：根据PRISMA（系统评价和荟萃分析的首选报告项目）声明，搜索了2022年3月之前发表的文章。如果他们调查了有/没有常规PD放置和有/没有早期UC移除的患者之间术后并发症的差异率，则认为研究合格。定义为在RARP后2-4天去除UC。
结果：总体而言，由5,112名患者组成的8项研究符合PD放置分析的条件，6项包含2,598例患者的研究符合UC切除分析的条件.任何并发症的发生率没有差异（合并比值比[OR]：0.89，95％置信区间[CI]：0.78-1.00），严重并发症(Clavien-Dindo分类≥III)(合并OR:0.95,95%CI:0.54-1.69),所有和/或有症状的淋巴结肿大(合并OR:0.82,95CI:0.50-1.33和合并OR:0.58,95CI:0.26-1.29)在有或没有常规PD放置的患者之间.此外，避免放置PD可降低术后肠梗阻的发生率(合并OR:0.70,95CI:0.51-0.91).早期消除UC导致尿潴留的可能性增加（OR：6.21，95CI：3.54-10.9）回顾性，但不是前瞻性研究。有或没有早期切除UC的患者之间吻合口漏和早期失禁率没有差异。
结论：在已发表的文章中，标准RARP后的常规PD放置没有益处。早期清除UC似乎有可能增加尿潴留的风险。而对中期失禁的影响尚不清楚。这些数据可以通过避免不必要的干预来帮助指导术后程序的标准化。从而减少潜在的并发症和相关成本。
方法：根据PRISMA（系统评价和荟萃分析的首选报告项目）声明，搜索了2022年3月之前发表的文章。如果他们调查了有/没有常规PD放置和有/没有早期UC移除的患者之间术后并发症的差异率，则认为研究合格。定义为在RARP后2-4天去除UC。
结果：总体而言，由5,112名患者组成的8项研究符合PD放置分析的条件，6项包含2,598例患者的研究符合UC切除分析的条件.任何并发症的发生率没有差异（合并比值比[OR]：0.89，95％置信区间[CI]：0.78-1.00），严重并发症(Clavien-Dindo分类≥III)(合并OR:0.95,95%CI:0.54-1.69),所有和/或有症状的淋巴结肿大(合并OR:0.82,95CI:0.50-1.33和合并OR:0.58,95CI:0.26-1.29)在有或没有常规PD放置的患者之间.此外，避免放置PD可降低术后肠梗阻的发生率(合并OR:0.70,95CI:0.51-0.91).早期消除UC导致尿潴留的可能性增加（OR：6.21，95CI：3.54-10.9）回顾性，但不是前瞻性研究。有或没有早期切除UC的患者之间吻合口漏和早期失禁率没有差异。
结论：在已发表的文章中，标准RARP后的常规PD放置没有益处。早期清除UC似乎有可能增加尿潴留的风险。而对中期失禁的影响尚不清楚。这些数据可以通过避免不必要的干预来帮助指导术后程序的标准化。从而减少潜在的并发症和相关成本。
