Impact of Clean Intermittent Self-Catheterization and Indwelling Catheterization on Perioperative Outcomes in Patients with Urinary Retention Undergoing BPH Surgery: A Comparative Monocentric Retrospective Study

Introduction and objectives: In case of acute urinary retention (AUR) due to benign prostatic hyperplasia (BPH) first trial without catheter (TWOC) may fail in about 30% of cases. In this situation most of patients have to keep an indwelling catheter (IDC) or to perform clean intermittent self-catheterization (CISC) until surgery.Although CISC has shown several advantages over IDC in neurologic patients, it is barely proposed in case of acute or chronic urinary retention due to BPH and comparative data on the outcomes of BPH surgery are very sparse.The aim of this study was to evaluate peri-operative outcomes of BPH surgery depending on the type of urinary drainage (IDC or CISC) in a population of patients with acute or chronic urinary retention and TWOC failure.

Patients and method: We retrospectively analyzed a prospectively maintained database on BPH surgery to retrieve the records of all men admitted for surgical treatment of BPH following acute or chronic urinary retention with TWOC failure over a one-year period of time (January to December 2022). Two groups were constituted depending on the type of urinary drainage at the time of surgery (IDC or CISC). Peri-operative outcomes were compared between groups regarding pre-operative urine culture, antibiotic consumption, post-operative complications, length of hospital stay, and spontaneous voiding after catheter removal.

Results: Between January and December 2022, 59 patients underwent BPH surgery after urinary retention and TWOC failure. At the time of surgery, 28 patients were on IDC (47%) and 31 patients were on CISC (53%). Despite a shorter delay between AUR and surgery in the IDC group (42 days vs. 80 days, p<0,01), patients had a significantly higher rate of pre-operative positive urine culture (100% vs. 51.6%, p < 0.01), received antibiotics more frequently (93% vs. 42%, p < 0.01), had a higher rate of post-operative complications (50% vs. 13%, p < 0.01), stayed longer in the hospital (3 days vs. 2 days, p= 0.02), and had a higher rate of post-operative retention (36% vs. 6.5%, p < 0.01).

Conclusion: In our experience, the use of CISC before BPH surgery improved peri-operative outcomes as compared to IDC. CISC reduced antibiotic consumption, post-operative complications, length of hospital stay, and improved micturition recovery after catheter removal.