Self-removal of Catheter after Robot-Assisted Radical Prostatectomy – A Feasibility Study

Objectives: Self-removal of urinary catheter as an option after Robot-Assisted Radical Prostatectomy (RARP) has never been explored in literature. We report the feasibility and outcome of the first study of this novel concept in our hospital. Patients and Methods We conducted a prospective audit of self-TWOC (trial without catheter) in men who underwent consecutive RARP in our centre between April 2022 and September 2022. Men who had self-TWOC filled a questionnaire about the outcomes of self-TWOC. Carbon footprint and carbon offset for each hospital TWOC avoided were calculated. Results Of the 129 who underwent self-TWOC, 112 filled the questionnaire and were hence included in the final analysis. Self-TWOC was successful in all the 112 (100%) men in the study. 99.1% of men were satisfied with self-TWOC at home. We managed to avoid 79.6+/-36.72 km of travel and 77 minutes of travel time for every self-TWOC. This also saved 85£/patient on clinic expenses and fuel cost savings of 9.87 to 15.99£ per patient depending on car engine size/type. The carbon footprint calculated was 20 Kilograms CO2 assuming average engine sized diesel/petrol cars and 10 Kilograms CO2 for average UK petrol hybrid car. The calculated carbon offset per patient for diesel/petrol cars: 0.32£, petrol hybrid: 0.16£. Self-TWOC for 80–160 patients will save the carbon emissions equivalent to that of a passenger on a London-New York Trans-Atlantic flight. Conclusion Self-TWOC is safe, affordable and is sustainable to the environment. Widespread acceptance of this practice change will be a small but steady step towards greener health systems across the world.