Predicting Initial Trial Without Catheter Failure After Prostate Deobstruction Surgery Using Preoperative Urodynamics

Area of Science:

• Urology
• Surgical Outcomes
• Lower Urinary Tract Symptoms

Background:

• Prostate deobstruction surgery effectively treats benign prostatic obstruction.
• Postoperative trial without catheter (TWOC) can fail, necessitating recatheterization.
• Identifying predictors of TWOC failure is crucial for patient management.

Purpose of the Study:

• To identify clinical and urodynamic predictors of initial TWOC failure after prostate deobstruction surgery.
• To improve postoperative management strategies for patients undergoing prostate deobstruction procedures.

Main Methods:

• Retrospective single-center study of 327 men undergoing prostate deobstruction surgery (2018-2024).
• Evaluation of clinical data, prostate volume, uroflowmetry, and multichannel urodynamics.
• Logistic regression analysis to determine factors predicting initial TWOC failure (recatheterization within 1 week).

Main Results:

• 12.5% of patients (41/327) experienced initial TWOC failure.
• Detrusor underactivity (DU) and low bladder outlet obstruction (BOO) were independent predictors of TWOC failure.
• Combined DU and low BOO significantly increased failure risk; high BOO with no DU decreased risk.

Conclusions:

• Preoperative urodynamics aid in stratifying initial TWOC failure risk.
• Patients with DU and low BOO may benefit from prolonged catheterization.
• Early catheter removal is feasible for patients with high BOO and preserved detrusor function, even with elevated PVR.