Introduction: Early catheter removal represents a potential opportunity to improve quality of life and limit treatment burden for patients undergoing BPH procedures. It has proven feasible in patients undergoing HoLEP but only under strict criteria. Furthermore, the influence of patient factors, such as post-operative bladder function, on early catheter removal has not been studied. To help address these limitations, we sought to determine if same day catheter removal was feasible in a generalizable population of HoLEP patients and if bladder pressure assessment could improve success rates.
Methods: From February 2021 to August 2021, we prospectively evaluated same day catheter removal for patients undergoing HoLEP. Patients were excluded if they had a history of atonic or hypocontractile bladder. All patients were anesthetized with general anesthesia and paralyzed. Criteria for proceeding with same day catheter removal included: an uncomplicated procedure, continuous bladder irrigation weaned within 120 minutes of arrival to PACU, minimal hematuria rated with a standardized scale and a bladder pressure over 30 cmH20 as measured using the VP TestTM device (SRS Medical).
Results: Over a 6-month period, 45 patients were enrolled in our study. The median age was 68 (IQR: 63.0-72.0) and prostate volume 79.1cc (IQR: 61.0-103.5). Criteria for catheter removal was met by 35 patients; 9 patients were unable to meet bladder pressure cutoffs and 1 was excluded for hematuria. Of those that attempted a trial of void, 29/35 passed for an effective pass rate of 83%. For those that failed trial of void, 100% had uncomplicated catheter replacement in PACU with a median catheter duration of 2 days (IQR: 1-3). Median maximum detrusor pressure for those that passed, failed, and did not attempt a trail of void were 55.0 cmH20 (IQR: 43.0-84.0), 46.0 cmH20 (IQR: 35.0-61.0) and 13.0 cmH20 (IQR: 8.0-23.0), respectively.
Conclusions: In a population of patients who received general anesthesia and paralysis for HoLEP, same day catheter removal is feasible. There are differences in measured post-operative bladder pressure between those that passed and failed trial of void. Bladder pressure measurements in the post-operative setting may be a helpful adjunct for those considering same day catheter removal in HoLEP patients.
Source of Funding: SRS medical supplied devices free of charge