Optimal duration of urethral catheterization in ThuLEP: A randomized prospective pilot study

Lower urinary tract symptoms (LUTS) from benign prostatic obstruction (BPO) are common in aging men. Surgical interventions such as TURP and laser enucleation are established treatments for drug-refractory BPO. Holmium laser enucleation (HoLEP) has demonstrated favorable long-term safety and efficacy with shorter hospitalization and catheterization times compared to standard TURP. Thulium laser enucleation (ThuLEP) emerges as an effective and safe option, potentially offering advantages including reduced blood loss and shorter catheterization periods compared to TURP. Postoperative catheterization duration following laser enucleation varies among institutions, with an increasing trend toward early catheter removal. Previous studies support the feasibility of same-day catheter removal after HoLEP in selected patients. This study aims to compare outcomes of 24-hour versus 72-hour catheterization following ThuLEP.

This randomized prospective pilot study was designed to explore whether 24-hour catheterization yields comparable outcomes to 72-hour catheterization in terms of postoperative voiding dynamics (Qmax), with the aim of generating preliminary evidence for future confirmatory trials. Patients were randomly assigned preoperatively to catheter removal at 24h (Group 1) or 72h (Group 2). Validated questionnaires (SF-36, ICIQ-SF, IPSS) were administered preoperatively, before discharge, and at follow-up, with uroflowmetry performed. A total of 42 patients (21 per group) were included.

No clinically significant differences were observed between groups. Postoperative complications occurred in 7 cases: 1 in the 24-hour group and 6 in the 72-hour group, including urinary leakage, hematuria, and acute urinary retention.

Early catheter removal at 24h following ThuLEP appears to yield comparable urinary function and patient-reported outcomes to the standard 72-hour protocol in this cohort. These preliminary findings support the feasibility of early catheter removal and provide a basis for future confirmatory trials.

Level 2 (or Level IIb).