Lower urinary tract symptoms after laser enucleation of the prostate in patients with and without preoperative indwelling catheter.

PURPOSE: To test for differences in outcomes of lower urinary tract symptoms (LUTS) between patients with and without preoperative indwelling catheter after laser enucleation of the prostate (LEP).

METHODS

In our tertiary-care database, patients undergoing LEP (11/2017-09/2023) were retrospectively analyzed, stratified by presence of preoperative catheter. Mixed linear models assessed International Prostate Symptom Score (IPSS) and quality of life (QoL) at 1, 3, 12, and 24 months after LEP. Multiple linear regression, adjusted for age and prostate volume, tested for differences in LUTS and QoL recovery.

RESULTS

Among 518 patients, 132 (25%) had a catheter before LEP (89% transurethral, 11% suprapubic), mainly due to acute urinary retention (82%). Mean catheter duration was 13 weeks; 48% exceeded 12 weeks. Catheter patients were older (71 vs. 69 years, p = 0.003), had higher PSA (8.3 vs. 5.8 ng/ml, p < 0.001), and larger prostate volume (98 vs. 86 ml, p = 0.004). At 1 month, catheter patients reported lower IPSS (7.1 vs. 9.8) and more favorable QoL (1.6 vs. 2.3). No significant differences were seen at 3, 12, and 24 months in adjusted IPSS. In regression analyses, preoperative catheter was associated with improved IPSS at 1 (coefficient -2.8, p < 0.001), 3 (-2.6, p < 0.001), and 12 months (-1.8, p = 0.007), as well as better QoL at 1 (beta -0.8, p < 0.001), 3 (-0.7, p < 0.001), and 12 months (-0.4, p = 0.01).

CONCLUSION

Patients with preoperative catheterization appear to experience similar long-term benefits from LEP compared to those without catheter, but show greater improvements in LUTS and QoL within the first postoperative year.