Early versus delayed foley catheter removal after transurethral resection of the prostate

Abstract

Background: Time of removal of the urethral catheter varies after the TURP. While some urologists remove the catheter on day 1 or 2 after TURP,
most wait for 4-7 days before removing the catheter. The keeping of a urethral catheter for 4-7 day may require that the patient stays
in the hospital for that duration of time to have the catheter removed before he goes home. The delayed catheter removal, therefore,
may prolong hospital stay. There is no data from our environment on when to remove the catheter after TURP. This study seeks to
compare early and delayed catheter removal after TURP for benign prostatic hyperplasia.
Patients and Method: This was a hospital-based prospective study carried out at a multi-specialty hospital in Jos, North-central Nigeria, comparing the outcomes of delayed (conventional) catheter removal with early removal of the catheter after TURP for BPH between December 2013 and January 2018. Patients with BPH who met the indications for TURP as well as consented to the study formed the subject of the study. Patients who had chronic retention prior to TURP and those who had significant perforation of the prostatic capsule and therefore required a longer  catheterization were excluded from the study. The patients and surgeons were not blinded to the procedure. All the consenting patients who had the TURP for various indications were blocked randomized into the two groups: Group A: early catheter removal (postoperative day 2) Group B: delayed catheter removal (postoperative day 4). The intraoperative and postoperative parameters were compared using appropriate statistics
Results: A total of 64 patients underwent the monopolar TURP for BPH during the period under review. Both groups had no statistically significant difference in their baseline characteristics. In groups A and group B, the number of patients that had urinary retention were 2(6.1%) and 2 (6.1%) respectively, and the difference was not statistically significant (p = 0.693). The number of patients that had UTI in group A and group B were 1(3.0%), and 4 (12.1%) and the difference was also not statistically significant (p = 0.178). One (3.0%) patient developed urethral stricture in group A and 1 (3.0%) also in group B with no statistical difference (p = 0.734). Three patients (9.1%) developed epididymorchitis in group B while none had this complication in group A (p = 0.119). Stress incontinence was seen in 1 (3.0%) patient in group A and also in 1 (3.0%) in group B with no statistical difference (p = 0.734) Bleeding complication was negligible in both groups after removal of the catheter.
Conclusion:Either early or delayed removal of the catheter after TURP does not add excessively to postoperative complications. Removal of a urethral catheter on postoperative day 2, favourably granted the reduced hospital stay and consequently reduced cost.

Keywords: TURP, early catheter removal, delayed catheter removal