Catheter strategy and functional recovery after robotic prostatectomy: a systematic review of suprapubic versus urethral drainage.

To evaluate whether catheter strategy (suprapubic versus urethral) influences functional and peri-operative recovery outcomes following Robotic Assisted Laparoscopic Prostatectomy (RALP). A PRISMA-2020 compliant systematic review was conducted. PubMed, Embase, Scopus, Web of Science, and Cochrane Library were searched to December 2025 using predefined MeSH terms. All comparative studies of SPC vs. UC following RALP were included irrespective of design. Primary outcomes were early (≤ 6 weeks) and late post-operative incontinence (≥3 months). Secondary outcomes were early post-operative pain (≤ 3 days) and late pain (> 3 days), unscheduled emergency department (ED) visits and urinary tract infections (UTIs). Risk of bias was assessed using ROB-2 for RCTs and ROBINS-I V2 for non-randomised studies. Thirteen studies met the inclusion criteria. Early incontinence favoured SPC, showing pooled risk ratio of 0.70 (95% CI 0.53–0.92, p = 0.02, I2 = 36%), however this was sensitive to inclusion of Retzius-sparing data. Late incontinence was similar between groups [pooled RR 0.74 (95% CI 0.42–1.30, p = 0.19)]. Early and late pain outcomes were modestly lower with SPC but did not reach statistical significance. ED visits and UTIs were comparable. Urethral strictures and bladder-neck contractures were rare with no group difference. The certainty of evidence was “very low” for early incontinence and “low” for late incontinence. Available evidence suggests that SPC may be associated with modest reduction in early post-operative incontinence following RALP. However, this effect is sensitive to surgical technique and does not sustain beyond the immediate post-operative period. Catheter route alone is unlikely to independently influence functional recovery in RALP and routine use of SPC over UC cannot be recommended.