Risk factors associated with unsuccessful initial trial without catheter following transurethral resection of prostate

Abstract

AIMS: Transurethral resection of prostate (TURP) remains the reference standard for treatment for patients with benign prostate hyperplasia (BPH). Although not uncommon, predictors for failed trial without catheter (TWOC) following TURP have not been well-investigated. This study aimed to identify risk factors associated with failed TWOC following TURP. METHODS: A retrospective analysis of patients who underwent TURP for BPH between July 2016 to March 2019 was conducted, with patients identified through our institutional database (CEDARS). Age, mode of presentation, pre-operative uroflowmetry parameters, type and duration of pharmacotherapy prior to surgery, pre-op ultrasound prostate volume, history of urinary tract infections (UTI), resected weight, surgeon seniority, and results following first TWOC were recorded. Statistical analysis was carried out using the t-test, Fisher’s exact test and chi-square test. P<0.05 deemed statistically significant. RESULTS: A total of 347 patients were eligible. 41 (12%) patients failed initial TWOC post-op. Only 3 (0.9%) patients failed further TWOC and required long-term catheterisation post-operatively, all with urodynamically proven detrusor underactivity. Failed initial TWOC post-TURP was statistically significantly associated with patients who required pre-operative treatment for urinary tract infections (UTI), presence of catheter pre-operatively, and duration of pharmacotherapy, but not pre-op TRUS prostate volume, pre-op residual volume, resected weight, or surgeon seniority. CONCLUSIONS: Failed initial TWOC post-TURP is not uncommon, although majority are able to void following further TWOC attempts. Patients with previous pre-op UTI, presence of catheter pre-operatively, and previous long-term pharmacotherapy for treatment of BPH are at increased risk of failed initial TWOC, and should be counselled adequately before TURP.