Background:
Drainage after pelvic surgery has been questioned in a number of trials and studies of non-urologic surgery. Radical prostate cancer surgery has been performed with routine pelvic drainage to evacuate urine, blood and lymph. Savoie et al were the first to suggest that prophylactic drainage of the pelvis after radical prostatectomy may not be necessary due to improved surgical approaches. Bladder neck preservation, precise anastomosis between urethra and urinary bladder, lymphadenectomy where indicated, and proper selection of patients may obviate the need for routine pelvic drainage. We report a consecutive series where radical prostatectomy was attempted without pelvic drainage.
Methods:
All patients had clinically localized prostate cancer. Complete clinical and pathological information was recorded prospectively in a database. The criteria for omission of pelvic drainage were:
1. Successful bladder neck preservation
2. Urethrovesical anastomosis performed using six interrupted sutures in open cases or
twelve continuous sutures in robotic cases
3. Watertight urethrovesical anastomosis upon irrigation
Catheters were removed routinely on the 9^th postoperative day. Most patients were discharged on the first or second postoperative day.
Results:
Of 266 consecutive patients with clinically localized prostate cancer subjected to open or robotic radical prostatectomy, a pelvic drain was not placed in 205 (77%) patients. Drain was omitted in 172 of 229 open cases (75%) and 33 of 37 (89%) robotic cases. Complication rates were similar between the two groups with and without pelvic drainage. Complications occurred in 8% in the group with pelvic drainage: postoperative stricture-3, recatheterization-1 and wound dehiscence-1. In the group without pelvic drainage, complications occurred in 6%: postoperative anastomotic stricture-4, recatheterization-4, lymphocele-3 and wound infection-1. In the last two years, 10% of 76 patients required pelvic drainage. Drains were placed due to tension at the urethrovesical anastomosis-3, fish mouth bladder neck deformity-2, large median lobe-1, rectal injury-1, and urinary bladder injury-1.
Conclusions
Pelvic drainage may be omitted after radical prostatectomy when the urethrovesical anastomosis is performed well. Drain omission may contribute to shortened hospital stays and reduced costs without added complications. These benefits may be extended safely to both open and robotic radical prostatectomy patients.

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