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Effect of Local Anesthetic-Eluting Foley Catheter (FreeFoley) on Urethral Pain and Discomfort After HoLEP: A

Byoungkyu Han¹, Ki-Hyuck Moon¹, Jae Hoon Chung²

¹Department of Urology, Perfect Urology Clinic, Seoul, the Republic of Korea.

European Urology Open Science

|July 11, 2026

Abstract

Background And Objective:

Benign prostatic hyperplasia (BPH) is common in middle-aged and older men and often requires surgical intervention. Postoperative Foley catheterization frequently causes urethral pain and catheter-related bladder discomfort (CRBD). Systemic analgesics may be insufficient and can be contraindicated in older patients. This study evaluated the efficacy and safety of a local anesthetic-eluting Foley catheter (FreeFoley) for reducing urethral pain and discomfort after holmium laser enucleation of the prostate (HoLEP).

Methods:

In this prospective multicenter observational study, 108 male patients aged 50-79 yr undergoing HoLEP were allocated to either an experimental group (FreeFoley with 2% lidocaine solution, infused at 1 ml/h) or a control group (FreeFoley with normal saline, 1 ml/h). Pain and discomfort were assessed using the visual analog scale (VAS) during postoperative recovery and immediately before catheter removal. Primary outcomes were VAS scores and systemic analgesic use; secondary outcomes included catheter-related complications and patient satisfaction.

Key Findings And Limitations:

VAS scores were significantly lower in the lidocaine group than in the control group on the day of surgery (3 [2-4] vs 4 [3-5], median difference [MD], -1.1, 95% CI, -1.7 to -0.4; p < 0.001) and at catheter removal (2 [1-3] vs 3 [2-4], MD, -0.6, 95% CI, -1.2 to -0.2, p < 0.001). Analgesic use was markedly reduced (5.6% vs 28%; risk ratio [RR], 0.20, 95% CI, 0.10-0.70, p < 0.001). Complications occurred in 11% of patients in both groups (RR, 1.00; 95% CI, 0.36-2.78). Limitations include nonrandomization, modest sample size, and short follow-up duration.

Conclusions And Clinical Implications:

The lidocaine-eluting Foley catheter was associated with modest reductions in postoperative urethral pain, discomfort, and systemic analgesic requirements without an observed increase in complications. Further well-controlled studies are warranted to confirm the clinical benefit before routine adoption.  Trial registration: Clinical Research Information Service (CRIS); KCT0011090.

Keywords:

Analgesic-eluting urethral catheter Benign prostatic hyperplasia Bladder discomfort HoLEP Lidocaine Prospective observational study

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