Extraurethral Foley catheter length: A surrogate marker for size of prostatic adenoma and a clinical predictor of trial without catheter success

Introduction: There are no reliable clinical markers to predict the size of the obstructing prostate and the success of trial without catheter (TWOC) in men with benign prostate enlargement (BPE) and acute retention of urine (AUR). TWOC fails in men with large prostates. Patients with a large prostate have a shorter extraurethral catheter length (EUCL). This prospective study was conducted to assess whether EUCL could be a surrogate clinical marker for prostatic enlargement and the success of TWOC. Methods: Alpha-blocker naïve men with AUR due to BPE underwent clinical, laboratory, and ultrasound assessment, and EUCL measurement. They were started on alpha-blockers before being subjected to TWOC. Patients with a successful TWOC were followed on medical management till October 2024 and were classified as pass. Patients who had retention (immediately or during follow-up) were classified as failures. Relationship of EUCL with prostate dimensions was evaluated. Regression analysis was performed to determine the clinical factors predicting the success of TWOC. Results: Amongst the 76 patients that were recruited, 43 failed the TWOC and 33 were voiding well with a median AUR-free time of 1059 days and a follow-up period of 2106 days. Patients in the failed group had larger prostates. EUCL had a significant negative correlation with the dimensions of the prostate. EUCL ≤170 mm had a significantly higher odds of failed TWOC (Odds ratio 7.92 [95% confidence interval 2.09–29.96], Z = 3.047, P = 0.002). Conclusions: Shorter EUCL can be an important clinical marker of the prostate size and a predictor of failed TWOC. In resource-poor settings, EUCL can be used to plan referral to urology services or TWOC.