Predicting Initial Trial Without Catheter Failure After Prostate Deobstruction Surgery Using Preoperative Urodynamics

Abstract

Purpose: Prostate deobstruction surgery is effective for relieving lower urinary tract symptoms in men with benign prostatic obstruction, yet some patients experience failure of the initial trial without catheter (TWOC) postoperatively and require recatheterization. This study aimed to identify clinical and urodynamic predictors of initial TWOC failure after prostate deobstruction surgery. Methods: A retrospective single-center study was conducted on 327 men who underwent prostate deobstruction surgery, including transurethral resection of the prostate, GreenLight laser photoselective vaporization, and holmium laser enucleation, at our institution from 2018 to 2024. Clinical characteristics, prostate volume, preoperative and postoperative uroflowmetry, and multichannel urodynamic parameters were evaluated. Initial TWOC failure was defined as recatheterization within 1 week of catheter removal. Logistic regression analysis was performed to identify predictive factors. Results: Among the 327 patients, 41 (12.5%) experienced initial TWOC failure. Uroflowmetry parameters improved significantly postoperatively. Multivariate analysis identified detrusor underactivity (DU) (odds ratio [OR], 2.773; P=0.012) and low bladder outlet obstruction (BOO) (OR, 2.881; P=0.041) as independent predictors. Patients with both risk factors exhibited a higher likelihood of initial TWOC failure (OR, 4.560; P=0.003), whereas those with high BOO and no DU showed lower risk (OR, 0.321; P=0.003). Notably, even among patients with high preoperative postvoid residual volume (PVR≥300 mL), those with high BOO and preserved detrusor contractility still demonstrated lower TWOC failure risk (OR, 0.154; P=0.018). Conclusions: Preoperative multichannel urodynamics enhance initial TWOC risk stratification and support individualized postoperative catheter management. Patients with DU and low BOO may require prolonged catheterization. In contrast, early catheter removal appears feasible in patients with high BOO and preserved detrusor function, even when preoperative PVR is elevated.