Good comment.  That raises an interesting question.  What, if any, is the
relationship between the time the catheter is left in and the incidence of
problems due to scarring?

My uro left that damn thing in for three full weeks and I still ended up
with an opening, that they tell me after the cysto, is about one third the
size that it should be.  In my case at least, leaving it in longer did not
prevent some scarring, but who is to say if the sucker would not have shut
all the way if the catheter had been removed much sooner?

Interesting question.  I had not thought of that relationship before.

I had my Foley for 3 weeks and a day.  During that time I had a lot of
blood, both in the urine and even some coming 'around' the catheter and
out the tip of the penis.  THere was enough of it that I borrowed
Carefree panty lines to protect my jockey shorts which I started
wearing to stablize the catheter tube after the Uro untaped my penis at
1 week post-surgery.

THe day my Foley was to come out (this past Tuesday) was the bloodiest
yet.  After it came out I had fairly good control during the day and
the blood disappeared completely.  My problems were when coughing,
sneezing or blowing my nose as well as some leaking when bending.  As
the day went on I had increasing discomfort when urinating.  By the
next morning I found about 10 AM I couldn't urinate at all.  By the
time I got to the Uro's office I was in major discomfort and he
catheterized me.  The nurse then taught me how to do it myself using a
coude tip catheter.

I first had to do it myself at about 2:30 AM Wednesday and again at
8:30 AM when I got out of bed.  I did urinate the rest of the day but
had to self-cath again 3 times Thursday and twice already today
(Friday).  The Uro's nurse said it happens sometimes and it's part of
healing and not to worry about it.

I think I'd still be doing this than have the Foley another week.
Judging from the presence of so much blood the Foley was really
irritating to me and now both are gone.  I'm sleeping much better in my
Depends brief than I was with the Foley - I can return to sleeping on
my sides and change position much easier without worrying about the
tubes.  THe bloody urine in the bag really had a rotten-egg smell also.

I hope you're wrong! Remember, mine was laparoscopic and the surgeon has
done 400 this way over the past 3 years with the same team here in
Boston. He's the only lap operator at MGH urology. Over the same period
the department has done a total of 800 or so more traditional open RRPs
and they compare outcomes in the usual competitive Harvard way. The open
patients keep their catheters at least 2 weeks I believe.

He seemed very aware of his outcomes and the literature. AFAIK his
theory is that the anastamosis sutures are technically better under
fibreoptic vision and that prolonged foreign body == increased risk of
infection and scarring. Do you know of  any reliable evidence for your
concern?

A quick pubmed search "bladder anastomosis catheter stricture" didn't
reveal any obvious contrary findings. Our japanese brethren appear to be
at risk of having foleys yanked at 3 days, while the 3rd paper below
might suggest 7 days is not so bad. I couldn't find anything suggesting
longer was necessarily better - but this was a half hearted search -
after all, it's too late for me! The 4th suggests that duration didn't
affect stricture risk but that (once again) cigarettes are a no no?

===========pub med abstracts of potential interest=================

Hinyokika Kiyo. 2004 Nov;50(11):773-7.     Related Articles, Links

    Early catheter removal and postoperative status of bladder outflow
after retropubic radical prostatectomy.

    Kanno T, Shibasaki N, Ito M, Tsuji Y, Taki Y, Takeuchi H.

    Department of Urology, Toyooka Public Hospital.

    Cystography was performed on 35 patients 6 to 7 days after
retropubic radical prostatectomy (RRP), to determine the feasibility of
early removal of the urinary catheter. The urethral catheter was removed
the same day if no extravasation was evident on cystography.
Uroflowmetry was also performed both immediately after early catheter
removal and at follow-up 4 to 20 months later. The urethral catheter
could be removed on postoperative day 6 or 7 from all but one patient.
Three patients developed acute urinary retention after catheter removal,
requiring reinsertion of a Foly catheter. During a mean follow-up of 8.3
months (range 4 to 20 months), 25 patients (71.4%) reported excellent
continence (requiring no pad) and seven patients (20%) good continence
(requiring a single pad). Immediately after early catheter removal, 12
patients (34%) showed obstruction on a maximum flow nomogram. The number
of patients with obstruction decreased to eight during follow-up, three
of whom suffered anastomotic stricture and one anterior urethral
stricture, all of which required urethrotomy. Our results show that
early catheter removal can be accomplished safely, although some
patients may have difficulty with urination or develop acute urinary
retention immediately after catheter removal, probably due to
anastomotic edema. On the other hand, if the patients develop difficulty
in urination some time after the operation, the possibility of
anastomotic or urethral stricture should be considered. Therefore we
recommend uroflowmetry within one year after RRP to identify anastomotic
or urethral stricture.

 Int J Urol. 2004 Nov;11(11):983-8.     Related Articles, Links
    Click here to read
    Early catheter removal 3 days after radical retropubic prostatectomy.

    Noguchi M, Shimada A, Yahara J, Suekane S, Noda S.

    Department of Urology, Kurume University School of Medicine,
Kurume, Fukuoka, Japan. noguchi@med.kurume-u.ac.jp

    AIM: We investigated the feasibility and safety of the early
removal of urethral catheters 3 days after radical retropubic
prostatectomy. METHODS: Seventy consecutive patients underwent radical
retropubic prostatectomy with the intent of early catheter removal on
postoperative day (POD) 3. Catheter removal was based on postoperative
cystograms performed on POD 2. Patients were analyzed using a validated
prostate cancer specific questionnaire (University of California, Los
Angeles Prostate Cancer Symptom Index) to determine quality of life
outcomes. Multiple logistic regression analysis was also used to
evaluate if any of the preoperative or intraoperative parameters were
able to predict the success of early catheter removal after radical
retropubic prostatectomy. RESULTS: The catheter was removed on POD 3 in
67 of 70 patients (97%) excluding three patients with moderate or severe
extravasation on postoperative cystograms. Of the 67 patients, 53 (76%)
were successful in early catheter removal, but the remaining 14 (24%)
patients experienced urinary retention within 48 h and were treated with
simple catheter replacement for 1 or 2 days. Two patients developed
anastomotic strictures 3 and 4 months postoperatively, which were
managed by dilation alone. Multiple logistic regression analysis showed
that no leak during an intraoperative leak test was the only independent
predictor of success for early catheter removal (P = 0.0069; odds ratio,
6.667; 95% confidence interval, 1.682-26.428). CONCLUSION: The present
study revealed that early catheter removal 3 days after radical
retropubic prostatectomy is feasible in patients who show a negative
intraoperative leak test. Postoperative monitoring of more patients is
needed to determine if the early catheter removal is widely applicable.

 Urology. 2003 Jan;61(1):156-60.     Related Articles, Links
    Click here to read
    Removal of urinary catheter on postoperative day 3 or 4 after
radical retropubic prostatectomy.

    Patel R, Lepor H.

    Department of Urology, New York University School of Medicine, New
York, New York 10016, USA.

    OBJECTIVES: To determine the feasibility and safety of removing the
urinary catheter on postoperative day (POD) 3 or 4 after radical
retropubic prostatectomy (RRP). METHODS: Between January 2001 and August
2001, gravity cystography was performed on POD 3 or 4 after RRP by a
single surgeon (H.L.) on 151 men. The urinary catheter was removed on
POD 3 or 4 providing no extravasation was evident on cystography.
Urinary catheters were replaced over a guidewire placed into the bladder
under flexible cystoscopic guidance in cases of acute urinary retention
(AUR). Continence was assessed at 3 months after RRP. RESULTS: Of the
151 cystograms performed on POD 3 or 4, 116 (76.8%) revealed no evidence
of extravasation. The indwelling catheters were removed in 114 of these
cases (98.3%). Twenty-two (19.3%) of the 114 men whose catheters were
removed on POD 3 or 4 developed AUR within 48 hours of catheter removal,
requiring catheter replacement. Two of these patients required repeated
surgery secondary to complications related to AUR. At 3 months after
RRP, 75% of the men whose catheters were removed on POD 3 or 4 required
no pads or a single pad during a 24-hour interval, and 77.6% reported
none or slight bother from incontinence. Of the 37 men whose catheters
were removed on POD 7 or later, 1 patient (2.7%) developed AUR, and the
catheter was replaced without complications. At 3 months after RRP,
65.7% of men whose catheters were removed on POD 7 or later required no
pads or a single pad during a 24-hour interval, and 71.4% reported none
or slight bother from incontinence. The incidence of anastomotic
stricture in men whose catheters were removed on POD 3 or 4 and POD 7 or
later was 12.1% and 22.6%, respectively. CONCLUSIONS: Most men will have
a watertight anastomosis on POD 3 or 4 after RRP. Early catheter removal
does not have a negative impact on continence or the rate of anastomotic
strictures. Because of the high incidence of AUR, requiring replacement
of the urinary catheter, and the potential for disruption of the
anastomosis or bladder neck reconstruction, we currently recommend
delaying catheter removal until POD 7 or later.

 Urology. 2000 Jul;56(1):96-100.     Related Articles, Links
    Click here to read
    Risk factors for vesicourethral anastomotic stricture after radical
prostatectomy.

    Borboroglu PG, Sands JP, Roberts JL, Amling CL.

    Department of Urology, Naval Medical Center San Diego, San Diego,
CA 92134-1005, USA.

    OBJECTIVES: Preoperative comorbidities associated with
microvascular disease may contribute to the development of bladder neck
contracture (BNC) by alteration of anastomotic healing. We investigated
potential risk factors for development of BNC after radical
prostatectomy (RP) and reviewed management of this complication.
METHODS: A retrospective review of 467 consecutive patients (mean age
63.2 years) undergoing RP between 1991 and 1999 was performed. In all
cases, the bladder neck was tailored to 20 to 22F in a racket handle
fashion. After mucosal eversion of the reconstructed bladder neck, a
mucosa-to-mucosa vesicourethral anastomosis was created over an 18 to
22F catheter using 4 to 6 anastomotic sutures. The relationship between
comorbidities identified preoperatively by patient interview and medical
record review (coronary artery disease [CAD], diabetes mellitus [DM],
hypertension [HTN], cerebral vascular accident, chronic obstructive
pulmonary disease, and smoking history) and the incidence of BNC was
determined. Risk factors including prior transurethral prostatectomy
(TURP), estimated blood loss (EBL), and operative time (OR time) were
also evaluated. Factors were evaluated for their ability to predict BNC
using both univariate and multivariate analysis. Treatment results for
BNC were also assessed. RESULTS: A total of 52 (11.1%) patients
developed BNC. Current cigarette smoking resulted in a significantly
higher (26%) rate of BNC (P <0.001). The BNC rate was also increased in
patients with CAD (26%, P <0.001), HTN (19%, P = 0.015), and DM (21%, P
= 0.030). Average OR time was longer (271 versus 249 minutes, P = 0.025)
and EBL was greater (1639 versus 1092 mL, P <0.001) in patients
developing a BNC. In multivariate analysis, current cigarette smoking
was the strongest predictor of BNC and independent of other factors (P
<0.001). BNC was not related to prior TURP, type of anastomotic suture
used, size of catheter, or duration of catheterization. Patients were
treated with transurethral dilation (73%) or transurethral incision
(27%) and 58% responded to the initial treatment. No patient became
incontinent as a result of the treatment for BNC.Conclusions. Several
comorbidities associated with microvascular disease are significant risk
factors for development of BNC after RP. Current cigarette smoking in
particular is a strong predictor. Transurethral dilation and
transurethral incision are equally effective as initial treatment of BNC.

    PMID: 10869633 [PubMed - indexed for MEDLINE]

Laparoscopic Radical Retropubic Prostatectomy.

Just RRP with the L in front.

I work for the Fed. Govt. - I'm good with these......:)

I'm adding an R for retropubic although you're right, it's redundant as
no one dose laps via the perineum AFAIK. I'll use LRP from now on...