Minimally invasive surgical therapies (MIST), including water vapor thermal therapy (WVTT) and prostatic urethral lift (PUL), are increasingly used for benign prostatic obstruction (BPO). However, predictors of catheter-free status and time to catheter removal remain unclear, particularly in patients with preoperative urinary retention. We aimed to identify clinically actionable predictors and establish a practical risk stratification model for catheter outcomes following MIST.

This multicenter retrospective cohort study included 377 patients undergoing MIST. The primary analysis focused on patients with preoperative urinary retention, defined as requiring an indwelling catheter or clean intermittent catheterization.
The primary outcome was catheter-free status within 6 months postoperatively. Secondary outcomes included time to catheter removal and identification of independent predictors.
Kaplan–Meier analyses were used to evaluate time to catheter removal. Multivariable logistic regression analysis was performed to identify independent predictors. Receiver operating characteristic (ROC) analysis was used to determine optimal cut-off values.

Kaplan–Meier analysis demonstrated that urinary retention ≥3 months was associated with significantly delayed catheter removal compared with <3 months (median 39 vs 29 days, log-rank p=0.018) (Figure 1).
Multivariable logistic regression analysis identified duration of number of preoperative BPH medications (≥2 vs ≤1: OR 2.62, 95% CI 1.18–5.79, p=0.018) and urinary retention (OR 1.02, 95% CI 1.00–1.03, p=0.041)  as independent predictors of failure to achieve catheter-free status (Figure 2).
ROC analysis identified clinically relevant thresholds of 3 months for urinary retention and ≥2 medications (AUC 0.74 and 0.69, respectively).
Based on these two factors, patients were stratified into three risk groups. A clear stepwise deterioration in outcomes was observed, with increasing risk burden associated with lower likelihood of achieving catheter-free status (p for trend=0.0027).
Procedure type (WVTT vs PUL) was not significantly associated with outcomes.

This study demonstrates that catheter-free outcomes after MIST can be predicted using two simple and readily available clinical variables.
The independent effects observed in the multivariable model (Figure 2), together with the delayed recovery patterns shown in Kaplan–Meier analysis (Figure 1), suggest that both prolonged urinary retention and treatment-refractory disease contribute to underlying bladder dysfunction.
Importantly, the lack of association between procedure type and outcomes indicates that patient-related factors, rather than procedural differences, primarily determine postoperative recovery.
These findings highlight the importance of early intervention before irreversible bladder impairment develops. This model balances statistical robustness with clinical simplicity, enabling immediate bedside risk stratification without additional testing or computational burden.

A simple two-factor bedside risk model enables practical and clinically meaningful prediction of catheter-free outcomes after MIST, regardless of procedure type.
Risk-based patient selection and timely intervention may improve outcomes and support individualized management strategies in patients with urinary retention.