A Prospective Study Comparing Suprapubic Catheter to Urethral Catheter on Voiding Outcomes and Complications After Whole-Gland Prostate Cryoablation for Prostate Cancer

Objective: This study aimed to prospectively compare the impact of suprapubic catheter (SPC) vs urethral catheter (UC) drainage on perioperative complications and functional outcomes after transperineal whole-gland prostate cryoablation for localized prostate cancer. Patients and Methods: Between October 2021 and December 2024, 67 patients underwent whole-gland prostate cryoablation at our institution; 52 were eligible for analysis, of whom 19 received an SPC and 33 a UC in a nonrandomized manner based on surgeon preference. Perioperative data were prospectively collected, including catheterization time, urinary retention, infections, and voiding outcomes at 12 months. Comparative analyses were performed, and logistic regression was used to identify predictors of post-treatment urinary retention. Results: The SPC group had a significantly longer median time to effective voiding trial than the UC group (50 vs 20 days, p = 0.022). Urinary retention necessitating transurethral operation occurred more frequently in the SPC group (26.3% vs 9.1%), although this did not reach statistical significance (p = 0.124). Seminal tract infections were observed exclusively in the SPC group (15.8%, p = 0.044). No significant differences were observed in de novo incontinence and 12-month voiding outcomes. Multivariable logistic regression with backward selection did not identify any independent predictors of higher odds of urinary retention. Conclusion: Compared with UC, the use of SPC after prostate cryoablation was associated with longer catheterization time and a higher rate of both urinary retention requiring operation and seminal tract infections. Although SPC may improve comfort, its use should be carefully individualized based on patient risk factors.