Prostate surgery outcomes in patients presenting with and without a urethral catheter: a long-term comparative study

Purpose To evaluate long-term catheter-free spontaneous voiding after surgery for benign prostatic enlargement (BPE) among patients presenting with an indwelling urethral catheter (IUC), using age-matched patients undergoing surgery for lower urinary tract symptoms (LUTS) without a catheter as a clinical reference group. Methods We retrospectively analyzed 481 patients treated for BPE at our center between January 2017 and March 2019 using open or endoscopic surgical techniques. Of 143 patients referred with an IUC, 143 age-matched patients operated on for LUTS alone were selected as a clinical reference group (total n = 286). Telephone follow-up was performed in late 2021 after a median of 2.5 years (IQR 637–1140 days). Results Patients with IUC had larger prostates, higher preoperative post-void residual volumes, and more positive urine cultures than patients with LUTS alone. Early postoperative retention was numerically more frequent in the IUC group, while long-term catheter dependence was 4% versus 2%. Conclusion Despite worse baseline urologic characteristics, most patients presenting with a preoperative indwelling urethral catheter achieved durable catheter-free spontaneous voiding at long-term follow-up after BPE surgery. Surgery may therefore be a reasonable option for appropriately selected catheterized patients.