Incidence and determinants of catheter-related bladder spasms following transurethral resection of the prostate; A prospective review of 80 cases.

Abstract

Background: Bladder spasms due to involuntary contraction of the bladder occur frequently following Transurethral resection
of the prostate (TURP). They may be aggravated by the presence of a catheter, blood clots, preoperative overactive bladder, or
preoperative ingestion of bladder stimulants like caffeine. These bladder spams are painful, and associated with peri-catheter
leakage of urine, increased post-operative bleeding, and often refractory to postoperative analgesia. The incidence and risk
factors for the occurrence of bladder spasms following TURP need to be reviewed and validated to ensure adequate patient
counseling and possible lifestyle modification before surgery. We conducted a prospective review of the determinants of
bladder spasms in our patients following TURP.
Methodology: The study population was patients with benign prostatic obstruction scheduled for TURP between March 2022
and April 2023. Monopolar transurethral resection of the prostate was done using a continuous flow resectoscope. The primary
endpoint of the study was occurrences of bladder spasms postoperatively before the trial without a catheter. Pain perception
during the spasms was assessed using a visual analog scale. Clinical data were collected and analyzed to determine their
association with the occurrence of bladder spasms postoperatively using regression analysis. Sub-group analysis was also done
to correlate significant variables with the severity of pain in patients with spasms.
Results: The mean age of the 80 patients reviewed was 66.9 ±8 years. Bladder spasms were seen in 41(51.2%) of the patients.
The presence of overactive bladder (OAB) symptoms and the use of bladder stimulants were statistically significant
determinants with a p-value of 0.003 and 0.026 respectively. The age of the patient, preoperative indwelling catheter, prostate
volume, and resection time were not statistically determinant variables in the occurrence of bladder spasms post-operatively.
61% had severe pains and 39% had mild pains. There was no significant correlation between the presence of OAB and the use
of bladder stimulants with the severity of pains in patients with bladder spasms after TURP.
Conclusions: Half of the patients are likely to have bladder spasms after TURP. The risk of having these spasms is higher in
patients with preoperative OAB or patients who are exposed to bladder stimulants. The severity of spasms is however
independent of these risk factors.