Transurethral resection of the prostate (TURP) is a very common procedure for men with lower urinary tract symptoms based on benign prostatic hyperplasia. After surgery the transurethral catheter will be removed and, in many hospitals, micturition is observed during 24 hours, to prevent patients developing urinary retention at home. The aim of this study is to measure the percentage of people who had a catheter replaced after sufficient micturition during the day. Furthermore we want to search for factors that can predict catheter replacement.

This retrospective single-institution observational study included all men who underwent a bipolar TURP from January 2016 to February 2018. Age, prostate volume, preoperative catheter use (transurethral/suprapubic catheter or clean intermittent catheterization (CIC)), urinary retention, method of anesthesia (spinal block or general anesthesia) and day of catheter removal were assessed. Urinary retention and catheter use were separately used during analysis, because some patients used only for a short term a catheter after urinary retention. After power analysis, with logistic regression analysis predicting factors were calculated (SPSS 22). During voiding trial insufficient voiding was defined as no spontaneous micturition, big post-void residual volume (> 350 mL) or when the residual volume was bigger then the voided volume. A catheter was also replaced in case of significant gross hematuria or fever.

305 patients were included, mean age 70.3 ± 7.8 years. A voiding trial was performed after removing the catheter. In 26.6 % a catheter was replaced, in 9.5 % because of a big post-void residual volume, in 8.2 % due to no spontaneous micturition, in 3.3 % there was significant gross hematuria, 3.0 % developed fever and 2.6 % developed urinary retention after at first good spontaneous micturition. When correcting for the measured factors, only preoperatively having a catheter or applying CIC is a negative predicting factor for replacing a catheter (table 1). When the catheter (in 56 %) was removed again the day after replacement, yet 73 % of these patients could be discharged without a catheter.

Only 2.6 % develops urinary retention in 24 hours after catheter removal when at first there was a successful voiding trial. Therefor patients with sufficient spontaneous voids after removing the catheter can be safely discharged on the same day. As a result the time in hospital can be reduced for most patients to one night. Because applying CIC preoperative is a significant negative factor for a catheter replacement, special attention should be paid to these patients. Since 73 % of repeat voiding trials is successful, it seems reasonable to make a second attempt the next day.

Patients with a successful voiding trial after bipolar TURP can safely be discharged home on the day of catheter removal. Patients using CIC preoperatively have a three times higher risk of replacement of a catheter. In 73 % a repeat voiding trial the following day is successful.