The following is a summary of “Neuromuscular Paralysis is not a Barrier to Same Day Catheter Removal After HoLEP,” published in the JANUARY 2023 issue of Urology by Narang, et al.
For a study, researchers sought to assess the feasibility of same-day catheter removal for holmium laser enucleation of prostate patients who received paralysis and to determine whether bladder pressure monitoring could predict successful catheter removal.
From February 2021 to February 2022, a study was conducted to evaluate same-day catheter removal for patients undergoing holmium laser enucleation of the prostate. The criteria for same-day catheter removal included an uncomplicated procedure, weaning of continuous bladder irrigation within 120 minutes of arrival to PACU, minimal postoperative hematuria, and a bladder pressure over 30 cmH20 as measured using the VP Test device (SRS Medical).
A total of 108 patients were enrolled in the study, with a median age of 68 years (IQR: 62.0-73.0) and prostate volume 80.8cc (IQR: 64.8-112.3). Of the enrolled patients, 83/108 (76.9%) met the criteria for catheter removal. Among the patients who attempted a trial of the void, 69/83 (83.1%) were successful. The median maximum detrusor pressure for those who passed and failed the trial of void were 51.0 cmH20 (IQR: 40.5 -68.0) and 48.0 cmH20 (IQR: 38.8-61.8), respectively (P = .53). Intraoperative Lasix administration was associated with a higher rate of trial of void success, with an OR (95%CI) of 5.8 (1.4, 29.5) [P = .02], while elevated preoperative PVR was associated with a lower success rate of trial of the void, with an OR (95%CI) of 0.6 (0.4, 0.9) [P = .01].
Same-day catheter removal is feasible for holmium laser enucleation of prostate patients who receive paralysis, with a more than 80% success rate. Bladder pressure monitoring did not help predict which patients would pass or fail the trial of the void. Intraoperative Lasix administration may help increase the same-day catheter removal success rate, while elevated preoperative PVR was associated with a lower success rate of trial of the void.