Predictive Value of Voiding Efficiency After Active Void Trial in Men Undergoing BPH Surgery

Voiding efficiency: a predictor of failed trial off catheter after transurethral resection of prostate

PURPOSE

Following transurethral resection of the prostate (TURP), there is no clear recommendation for the catheter duration, and objective criteria are needed to determine appropriate time for trial off catheter. Current study is aimed to identify the high-risk patients for failed trial off catheter and the association with preoperative voiding efficiency with postoperative failed trial without catheter.

METHODOLOGY

This is cross-sectional single institutional study. All eligible patients who underwent TURP were followed preoperatively for symptoms and workup, including voiding efficiency based on ultrasound findings, intraoperatively for resection parameters, and postoperatively for a trial off a catheter. All the findings were documented, and the data were analyzed on SPSS(TM) 22. Demographic variables were calculated in the form of frequency and percentages. The association of voiding efficiency with failed trials off catheters was checked through Chi-square and binary logistic regression analysis.

RESULTS

132 patients were included in the study. The mean voiding efficiency was 57.5%. Based on voiding efficiency cut off, of 50%, patients were divided into two groups. The association between voiding efficiency and failed trials off catheters was not found to be statistically significant, with a p value of 0.79. Only prevoid volume, postvoid volume, duration of symptoms, and upper tract damage were found to be statistically significant predictors of failed trial off catheter, with a p value of < 0.05.

Prostatic urethral lift for subjects in urinary retention (PULSAR): 12-Month results of a prospective controlled trial compared with real-world outcomes

Objective

To examine the safety and efficacy of prostatic urethral lift (PUL) in acute urinary retention (AUR) patients within a controlled (PULSAR) and real-world setting (Real-World Retrospective study).

Materials and methods

PULSAR was a 12-month prospective study of PUL in AUR patients (n = 51) performed at six centres in the United Kingdom; enrolled BPH patients aged ≥50 years, with prostate volume of ≤100 cc. AUR was defined as being catheter dependent with at least one prior failed trial without catheter (TWOC) while on an alpha-blocker. RWR consisted of 3226 consecutive PUL patients across 22 international sites treated between July 2017 and March 2020; 469 of whom were in urinary retention (RWRr), that is, catheter-dependent at the time of their procedure. Symptom response, uroflow and catheter independence rates were compared between PULSAR and RWRr subjects. A logistical regression model was constructed to evaluate patient baseline and dynamic factors predicting success after the procedure.

Results

Seventy-three percent of PULSAR subjects were catheter independent and free from surgical reintervention at 12 months post-PUL. Success was associated with higher voiding efficiency during the perioperative period. Slightly higher catheter-independent rates (80%) were seen in RWRr patients; variables that influenced success included age <70 years, lower baseline prostate-specific antigen (PSA), lower baseline post-void residual (PVR) and shorter pre-procedural catheter duration. Logistic regression of the combined PULSAR and RWRr retention groups revealed that procedural age <70 years and higher bladder voiding efficiency (BVE) were associated with success.

Conclusions

Lower baseline PSA and PVR, younger age and shorter pre-procedure catheter durations drove successful outcomes in AUR patients undergoing PUL. Post-PUL voiding efficiencies may help ascertain long-term response to treatment.