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

Our study was motivated by the need to evaluate the best preoperative urinary drainage strategy for patients with urinary retention secondary to benign prostatic hyperplasia (BPH) undergoing surgery. Acute and chronic urinary retention represent challenging scenarios in urological practice, often necessitating interim bladder drainage. While clean intermittent self-catheterization (CISC) is underutilized in this context, it has demonstrated advantages in other patient populations, such as those with neurogenic bladder dysfunction.

We retrospectively analyzed 59 patients with failed trials without catheters (TWOC) who underwent BPH surgery and found that perioperative outcomes were significantly better in patients using CISC compared to indwelling catheters (IDC). Despite the shorter delay between retention and surgery in the IDC group, this group exhibited higher rates of preoperative bacteriuria (100% vs. 51.6%), postoperative complications (50% vs. 13%), and longer hospital stays (3 days vs. 2 days). Importantly, the ability to void spontaneously after surgery was markedly better in the CISC group (93.5% vs. 64%).

These findings highlight the benefits of CISC in improving surgical outcomes while reducing the burden of antibiotic use and hospital resource utilization. The structured CISC education provided in our institution's daycare unit may have contributed to these positive outcomes by ensuring patient competency and adherence. However, limitations, including potential selection bias and the retrospective nature of the study, warrant further investigations. Encouragingly, these results are set to be validated by an upcoming prospective multicenter French study (Comparing clean intermittent self-catheterization and indwelling catheterization for the management of urinary retention before BPH surgery: a multicentric randomized trial [CATHTERS]), which is expected to begin inclusions shortly.

In conclusion, our results underscore the need for a paradigm shift toward the broader adoption of CISC in the management of urinary retention before BPH surgery. By mitigating infection risks and enhancing postoperative recovery, CISC represents a valuable tool in optimizing the perioperative care of patients with BPH.

Written by: Louis Denimal, Clément Klein, Grégoire Capon, Eric Alezra, Jean-Christophe Bernhard, Vincent Estrade, Peggy Blanc, Franck Bladou, and Grégoire Robert

Department of Urology, Bordeaux Pellegrin University Hospital, Bordeaux, France

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