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Neuromuscular paralysis is not a barrier to same day catheter removal after HoLEP

Published:November 15, 2022DOI:https://doi.org/10.1016/j.urology.2022.10.020

      Abstract

      Objective

      To determine if same day catheter removal is feasible in a population of HoLEP patients who received paralysis and if bladder pressure monitoring could predict successful catheter removal.

      Methods

      From February 2021 to February 2022, we evaluated same day catheter removal for patients undergoing HoLEP. Criteria for proceeding with same day catheter removal included: an uncomplicated procedure, continuous bladder irrigation weaned within 120 minutes of arrival to PACU, minimal postoperative hematuria and a bladder pressure over 30 cmH20 as measured using the VP TestTM device (SRS Medical).

      Results

      108 patients were enrolled, with a median age of 68.0 years (IQR: 62.0-73.0) and prostate volume 80.8cc (IQR: 64.8-112.3). Criteria for catheter removal was met by 83/108 (76.9%) patients. Of those that attempted a trial of void, 69/83 passed for an effective pass rate of 83.1%. Median maximum detrusor pressure for those that passed and failed were 51.0 cmH20 (IQR: 40.5 -68.0) and 48.0 cmH20 (IQR: 38.8-61.8) [p = 0.53], respectively. Intraoperative Lasix administration was associated with a higher rate of TOV success and preoperative PVR was associated with lower TOV success, with OR (95%CI) of 5.8 (1.4, 29.5) [p=0.02] and 0.6 (0.4, 0.9) [p=0.01], respectively.

      Conclusion

      Same day catheter removal is feasible in those who receive neuromuscular paralysis, with a success rate >80%. Bladder pressure monitoring did not assist with differentiating which patients will pass or fail a trial of void. Intraoperative Lasix administration may be helpful in increasing success for same day catheter removal while elevated preoperative PVR was associated with TOV failure.

      Key words

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