Effectiveness of a New Guideline (Care map) to Reduce Catheter Indwelling Time after TUR-P in Siriraj Hospital
Objective: To study the effectiveness of new guideline for 3 days duration of catheter indwelling post TUR-P. To identify prediction factors in the patients who follow the guideline.
Material and Methods: 115 BPH patients in Siriraj hospital who had indication for TUR-P were studied. The new guideline was consisted of removal of indwelling catheter if hematuria does not occur after 24 hours discontinuing of CBI (continuous bladder irrigation).The main outcomes were percentage of cases followed the new guideline. Percentage of acute complication, re-catheterization and re-admission were measured and interpreted as secondary outcome.
Result: More than 90% of patients were older than 60 years old and more than 50% had co-morbid diseases. The percentage of the patients who followed the new guideline and could remove the catheter within 3 days was 52.2% and the catheter was removed in day 4 : 37.4%. There was five patients who needed re-catheterization and only two patients were in the group that followed the new guideline. There was no re-admission in this study. The predictor factors for early catheter removal (within 3 days post TUR-P) were number of normal saline solution irrigation, manual irrigation and fever in day 2 post TUR-P.
Conclusion: The new guideline was effective without increased complication. So it was safe and should be applied in TUR-P patients.
Chander J, Vanitha V, Lal P, Ramteke VK. Transurethral resection of the prostate as catheter-free day-care surgery. BJU Int 2003: 92(4): 422-5.
Chalise PR, Agrawal CS, Pandi RK. Reduction of length of hospital stay after transurethral resection of prostate by early catheter removal : A retrospective analysis. Nepal Med Coll J 2007; 9(2): 84-7.
Cherrie RJ, Young RA, Cattolica EV. The safety of overnight hospitalization for transurethral prostatectomy: A prospective study of 200 patients. J Urol 1998; 159(1): 210.
Nakagawa T, Toguri AG. Early catheter removal following transurethral prostatectomy: A study of 431 patients. Med Princ Pract 2006; 15: 126-30.
Nadler RB, Catalona WJ, Hudson MA, Ratliff TL. Early catheter removal following transurethral prostatectomy-impact on length of hospital stay. J Urol 1994; 74: 61-3.
Aslan G, Celebi I, Arslan D, Esen AA. Early catheter removal following transurethral prostatectomy: Overnight catheterization. Urol Int 2002; 68(2): 105-8.