Feasibility Of Removal Of The Urinary Catheter Within 6 Hours After Holmium Laser Enucleation Of The Prostate

BackgroundBenign prostatic hyperplasia(BPH),which causes lower urinary tract symptoms(LUTS),is a common diagnosis among the aging male population with increasing prevalence.BPH is nearly ubiquitous in the aging male with increases starting at age40-45 years,reaching 60% by age 60,and 80% by age 80.TURP is the historical gold standard therapy for LUTS secondary to obstruction from BPH.However,it also has some drawbacks,such as being generally suitable for prostate volumes smaller than80 m L and the possibility of BPH recurrence after surgery.Several new techniques,including holmium laser enucleation of the prostate(HoLEP),have been introduced as an alternative surgery to TURP for treating BPH.In the most important randomized studies comparing HoLEP with TURP and open surgery,length of hospital stay(LOS)ranged from 2.2 to 2.6 days.This is mainly due to the risk of hematuria and urinary retention after catheter removal.However,prolonged catheterization time can lead to patients experiencing constipation,decreased mobility,and increased risk of urinary tract infection.Early removal of catheter after the operation is an important process of rapid recovery after surgery.Whether the catheter can be successfully removed within 6 hours is influenced by many reasons.At present,it is unclear which factors will influence catheter removal within 6 hours after surgery.PurposeTo assess the feasibility of removal of the urinary catheter within 6 hours after HoLEP and investigate the risk factors for delayed removal of the urinary catheter after HoLEP to provide a theoretical basis for early removal of the urinary catheter and shortening LOS.Materials and MethodsRetrospectively collected complete clinical data of 81 patients who underwent HoLEP from January 2021 to December 2022 were analyzed.Patients who had their catheter removed within 6 hours after surgery were classified as Group A,while those who failed catheter removal were classified as Group B.Factors related to the perioperative period and catheter removal failure were analyzed.Results21(25.9%)patients were removed the urinary catheter within 6 hours after HoLEP.The preoperative Qo L(P<0.003),preoperative Qmax(P<0.001),and preoperative urinary retention(PUR)(P<0.011)were significantly different between the 2 groups.A predictive model using logistic regression was defined as follows:PRE(P)=-0.691-1.193×(Qo L)+0.553×(Qmax)-3.585×(PUR)with the area under the curve of 0.894 obtained from the ROC curve analysis.The predictive model had a cut-off value of-3.2385,the sensitivity for predicting the failure of removal of the urethra was 81.0% and the specificity was 88.3%.ConclusionThis study demonstrated that the preoperative Qo L(>5.5),the preoperative Qmax(<10.5ml/s),and PUR are independent factors associated with the failure of removal of the urethral catheter within 6 hours after HoLEP.A predictive model constructed using logistic regression analysis can help clinicians assess whether patients can have their urinary catheter removed within 6 hours after HoLEP and has good reference value in clinical practice.