MP25-01 URODYNAMIC TESTING MAY NOT BE NECESSARY PRIOR TO PROSTATECTOMY FOR BENIGN PROSTATIC ENLARGEMENT IN PATIENTS WITH INDWELLING CATHETERS

Abstract

INTRODUCTION AND OBJECTIVE: Patients treated for acute urinary retention (AUR) who failed catheter withdrawal are usually referred for surgery. Since the pathophysiology might be combined (bladder outlet obstruction+detrusor underactivity), some of these patients are referred for urodynamic evaluation, a test which is both invasive and expensive. We assessed the need for urodynamic testing in patients with an indwelling catheter prior to surgery. METHODS: This retrospective analysis comprised 145 patients treated in our center for AUR with an indwelling catheter, who underwent surgery for benign prostate enlargement (BPE), whether open (suprapubic, retropubic) or endoscopic [transurethral resection of the prostate (TURP), holmium last enucleation (HoLEP)] from 01/2017 to 03/2019. RESULTS: There were 145 patients with a median age of 72 years (IQ range 66-76 y). Of them, 62 (42%) underwent TURP, 53 (63%) HOLEP, and 30 (20%) open surgery. Acute retention had a median value of 1000 cc (700-1300 IQR). Twenty-six patients (18%) presented with a non-painful AUR. Median size of prostate was 90 cc (IQ range 60-120 cc). Eleven patients (7.5%) had urodynamic evaluation prior to surgery, 5 of whom had detrusor underactivity. Sixty-three patients (44%) had at least one failed catheter withdrawal attempt prior to surgery. Median time to surgery was 60 days (IQ range 30-90 d). Three patients had undergone prior surgery for BPE (all 3 had TURP). After a follow-up of 46 days (IQ range 34-121) from the day of discharge, 142 patients (98%) had successful catheter withdrawal. Of the 8 patients (6%) who were discharged with a catheter after surgery, 6 managed catheter withdrawal during the following month. Only 2 patients (1.5%) were unsuccessful. Both underwent TURP for a small prostate (smaller than 35 cc), and one was diagnosed postoperatively with small cell prostate cancer. He was able to urinate following chemo-radiation and a Re-TURP. CONCLUSIONS: Success rate of catheter withdrawal after open or endoscopic surgery for BPE in patients with an indwelling catheter is 98%. The only 2 patients for which surgery did not yield catheter removal had small prostates. From our results, it would seem that there is no need for urodynamic evaluation prior to surgery in patients with an indwelling catheter and a prostate larger than 35 cc.