Safety of a first-day catheter removal after transurethral resection of the prostate (TURP): a propensity score-matched historical control study
Keywords:TURP, early postoperative catheter removal, community-based hospital
Objective: Transurethral resection of the prostate (TURP) is the standard surgical management for patients with benign prostatic hyperplasia (BPH). Postoperative maintenance of bladder catheterization is a routine procedure. However, the timing of catheter removal varies. Our objective is to evaluate the safety of early catheter removal (less than 24 hours) whilst maintaining efficacy, especially in an overcrowded community-based hospital, which has a high rate of preoperative catheterization (47.7%).
Materials and Methods: This was a prospective and retrospective observational cohort study of 399 TURP indicated patients from February 2014 to September 2019. Since October 2017, the urological unit protocol has changed the process of removal of the catheter to less than 24 hours after monitoring for safety. Data from 95 patients after October 2017 was prospectively collected as the less than 24 hours group. The information from 2014 to October 2017 was collected and used as the control group. Data was then studied retrospectively for three years. The primary outcome, morbidity, and postoperative stay were compared with a 1:1 nearest neighbor propensity score-matched analysis.
Results: After the score was matched and balanced, there was no difference as regards complications between the two groups (Odd ratio (OR): 1, (95% Confidence interval (95% CI): 0.14-7.10, p-value: 1.00). Acute urinary retention and postoperative bleeding were also comparable (OR: 0.5, 95% CI: (0.05-5.51), p-value: 0.57, and p-value: 0.99). The postoperative hospital stay was significantly less in the < 24 hours group (38.1 less hours, 95% CI: (41.82- 34.31), p-value: < 0.01).
Conclusion: After TURP early catheter removal was safe even in the hospital with a high preoperative catheterization rate. Experienced surgeons, well-educated and compliant patients without contraindications (neurogenic bladder, urethral stricture, stroke, and some intraoperative complications: urinary bladder perforation, urinary tract infection, prostatic capsule perforation, or intraoperative bleeding) are our recommendation for adopting this protocol.
Ballentine Carter H, Coffey DS. The prostate: An increasing medical problem. The Prostate 1990;16:39-48.
Berry SJ, Coffey DS, Walsh PC, Ewing LL. The development of human benign prostatic hyperplasia with age. J Urol 1984;132:474-9.
Tantiwong A, Nuanyong C, Vanprapar N, Swasdipala P, Chittapraphai S. Benign prostatic hyperplasia in elderly Thai men in an urban community: the prevalence, natural history and health related behavior. J Med Assoc Thai 2002;85:356-60.
Trueman P, Hood SC, Nayak US, Mrazek MF. Prevalence of lower urinary tract symptoms and self-reported diagnosed ‘benign prostatic hyperplasia’, and their effect on quality of life in a community-based survey of men in the UK. BJU Int 1999;83:410-5.
Welch G, Weinger K, Barry MJ. Quality-of-life impact of lower urinary tract symptom severity: results from the Health Professionals Follow-up Study. Urology 2002;59:245-50.
Lee YT, Ryu YW, Lee DM, Park SW, Yum SH, Han JH. Comparative Analysis of the Efficacy and Safety of Conventional Transurethral Resection of the Prostate, Transurethral Resection of the Prostate in Saline (TURIS), and TURIS-Plasma Vaporization for the Treatment of Benign Prostatic Hyperplasia: A Pilot Study. Korean J Urol 2011;52:763-8.
Yip SK, Chan NH, Chiu P, Lee KW, Ng CF. A randomized controlled trial comparing the efficacy of hybrid bipolar transurethral vaporization and resection of the prostate with bipolar transurethral resection of the prostate. J Endourol 2011;25:1889- 94.
Gratzke C, Bachmann A, Descazeaud A, Drake MJ, Madersbacher S, Mamoulakis C, et al. EAU Guidelines on the Assessment of Non-neurogenic Male Lower Urinary Tract Symptoms including Benign Prostatic Obstruction. Eur Urol 2015;67:1099-109.
Das Bhagia S, Mahmud SM, El Khalid S. Is it necessary to remove foleys catheter late after transurethral prostatectomy in patients who presented with acute urinary retention secondary to benign prostatic hyperplasia? J Pak Med Assoc 2010;60:739-41.
Nakagawa T, Toguri AG. Early catheter removal following transurethral prostatectomy: a study of 431 patients. Med Princ Pract 2006;15:126-30.
McDonald CE, Thompson JM. A comparison of midnight versus early morning removal of urinary catheters after transurethral resection of the prostate. J Wound Ostomy Continence Nurs 1999;26:94-7.
Ganta SB, Chakravarti A, Somani B, Jones MA, Kadow K. Removal of catheter at midnight versus early morning: the patients’ perspective. Urol Int 2005;75:26-9.
Irani J, Fauchery A, Dore B, Bon D, Marroncle M, Aubert J. Systematic removal of catheter 48 hours following transurethral resection and 24 hours following transurethral incision of prostate: a prospective randomized analysis of 213 patients. J Urol 1995;153:1537-9.
Koh KB, MacDermott JP, Smith PH, Whelan P. Early catheter removal following transurethral prostatectomy--impact on length of hospital stay. Br J Urol 1994;74:61-3.
Phipps S, Lim YN, McClinton S, Barry C, Rane A, N’Dow J. Short term urinary catheter policies following urogenital surgery in adults. Cochrane Database Syst Rev 2006:CD004374.
Benedetto U, Head SJ, Angelini GD, Blackstone EH. Statistical primer: propensity score matching and its alternatives. Eur J Cardiothorac Surg 2018;53:1112- 7.
Garrido MM, Kelley AS, Paris J, Roza K, Meier DE, Morrison RS, et al. Methods for constructing and assessing propensity scores. Health Serv Res 2014;49:1701-20.
Dodds L, Lawson PS, Crosthwaite AH, Wells GR. Early catheter removal: a prospective study of 100 consecutive patients undergoing transurethral resection of the prostate. Br J Urol 1995;75:755-7.
Shum CF, Mukherjee A, Teo CP. Catheter-free discharge on first postoperative day after bipolar transurethral resection of prostate: clinical outcomes of 100 cases. Int J Urol 2014;21:313-8.
Durrani SN, Khan S, Ur Rehman A. Transurethral resection of prostate: early versus delayed removal of catheter. J Ayub Med Coll Abbottabad 2014;26:38-41.
Griffiths R, Fernandez R. Strategies for the removal of short-term indwelling urethral catheters in adults. Cochrane Database Syst Rev 2007; 2007(2):CD004011.
Khan A. Day care monopolar transurethral resection of prostate: Is it feasible? Uro Ann 2014;6:334-9.
Mueller EJ, Zeidman EJ, Desmond PM, Thompson IM, Optenberg SA, Wasson J. Reduction of length of stay and cost of transurethral resection of the prostate by early catheter removal. Br J Urol 1996;78:893-6.
Kirollos MM. Length of postoperative hospital stay after transurethral resection of the prostate. Ann R Coll Surg Engl 1997;79:284-8.
Chander J, Vanitha V, Lal P, Ramteke VK. Transurethral resection of the prostate as catheter-free day-care surgery. BJU Int 2003;92:422-5.