To evaluate the efficacy and safety of benign prostatic obstruction (BPO) surgery in patients with preoperative urinary catheterization.
We conducted a multi-institutional retrospective study including all patients who failed a trial without catheter (TWOC) after acute urinary retention (AUR) between January 2017 and January 2019. Patients with neurogenic bladder, prostate cancer or urethral stricture were excluded from the analysis. Patients underwent either monopolar/bipolar transurethral resection of the prostate (TURP), photoselective vaporization of the prostate (PVP), prostate artery embolization (PAE), open prostatectomy (OP) or endoscopic enucleation. The primary endpoint was 12-month urinary catheter free-survival without using benign prostatic hyperplasia (BPH)-medications.
One hundred and seventy one consecutive men (median age: 71 years; median prostate volume: 75 cm³) underwent BPO-surgery including 48 (28%) TURP, 62 (36.3%) PVP, 21 (12.3%) endoscopic enucleation, 15 (8.8%) PAE and 25 (14.6%) OP. The median duration of preoperative urinary catheterization was 69 days (IQR 46-125). The twelve-month urinary catheter free-survival rate was 84.8% (145/171). Satisfactory voiding returned to 121 patients (70.8%). On backward stepwise multivariable analysis, PVP (OR 0.27[0.10-0.69]; p=0.008), PAE (OR 5.27[1.28-27.75]; p=0.03), endoscopic enucleation (OR 0.08[0-0.49]; p=0.023), OP (OR 0.10[0.01-0.57]; p=0.034), Charlson score (OR 1.36[1.14-1.66]; p=0.001) and number of preoperative TWOC failure (OR 2.53[1.23-5.51]; p=0.014) were significantly associated with catheter free-survival.
In this multi-institutional retrospective study including patients with preoperative catheterization, the overall success rate of BPO-surgery was 70.8% after one-year follow-up. Compared to TURP, enucleation methods and PVP were associated with better catheter free-survival, while PAE was associated with higher risk of AUR recurrence.
Journal of endourology. 2020 Aug 19 [Epub ahead of print]
Bastien Gondran-Tellier, Robin McManus, Pierre-Clément Sichez, Akram Akiki, Sarah Gaillet, Harry Toledano, Marc Andre, Veronique Delaporte, Vincent Vidal, Gilles Karsenty, Cyrille Bastide, Dominique Rossi, Eric Lechavallier, Romain Boissier, Michael Baboudjian
Aix-Marseille Université, APHM, Department of Urology and Renal transplantation, Marseille, France; ., Aix-Marseille Université, APHM, Department of Urology and Renal transplantation, Marseille, France; ., Aix-Marseille Université, APHM, Department of Urology and Renal transplantation, 13005, France; ., Aix-Marseille Université, APHM, La Conception Academic Hospital, Department of Urology and Renal Transplantation, 13005, France; ., Aix-Marseille Université, APHM, La Conception Academic Hospital, Department of Urology and Renal Transplantation, Marseille, France., Martigues Hospital, Martigues, France, Department of Urology, Martigues, France; ., Aix-Marseille University, Dept. of Radiology and Medical imaging, Marseille, France; ., Paris, France; ., Aix-Marseille-University, 128791, Dept. of Radiology and Medical imaging, Marseille, Provence-Alpes-Côte d'Azur, France; ., Assistance Publique Hopitaux de Marseille, 36900, Urologie, Marseille, Provence-Alpes-Côte d'Azu, France; ., Aix-Marseille Université, APHM, Nord Academic Hospital, Department of Urology, Marseille, France; ., Aix-Marseille Université, APHM, Nord Academic Hospital, Department of Urology, Marseille, France; ., hopital La Conception, Urologie, 147 bd Baille, Marseille, France, 13385; ., Aix-Marseille-University, 128791, urology and kidney transplantation, Marseille, Provence-Alpes-Côte d'Azur, France; ., Aix-Marseille Université, APHM, Department of Urology and Renal transplantation, 147 bd baille, Marseille, France, 13005.