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

Abstract

Aim: Transurethral resection of prostate (TURP) remains standard for treatment for patients with benign prostate hyperplasia (BPH). Although not uncommon, few articles so far had investigated on the predictors for failed trial without catheter (TWOC) following TURP. This study aimed to identify risk factors associated with failed TWOC following TURP. Methods: This is a retrospective study of patients who underwent TURP for BPH between April 2017 to March 2019 in Queen Mary Hospital and Tung Wah Hospital. Patients were identified through our institutional database (CDARS). Demographics, mode of presentation, pre‐operative uroflowmetry parameters, type and duration of pharmacotherapy prior to surgery, ultrasound prostate volume, history of urinary tract infections (UTI), resected weight, surgeon seniority, and results following first TWOC were recorded. Results: A total of 412 patients were included. 50 (12.1%) patients failed initial TWOC post‐op. Only 7 (0.02) patients failed further TWOC and required long‐term catheterisation post‐operatively, 6 of them with urodynamically proven detrusor underactivity. Failed initial TWOC post‐TURP was found statistically significantly associated with whether patients initially presented as acute retention of urine (P = 0.005), whether they required catherization prior to operation (P = 0.001), urine volume of first catheterization (P = 0.002) (>500 ml P = 0.003, >800 ml P < 0.001, >1000 ml P < 0.001), and duration of taking alpha‐blocker pre‐operatively (P = 0.033). Conclusion: Failed initial TWOC post‐TURP is not uncommon, yet only small portion of patients failed further TWOC and required long‐term catheterisation due to detrusor underactivity. Routine preoperative urodynamic study is unnecessary and patients with risk factors of failed initial TWOC should be counselled adequately before TURP.