Login to Access Video or Poster Abstract: MP13-17
Sources of Funding: Agency for Healthcare Research & Quality (AHRQ)

Introduction

Transurethral prostate surgery is commonly used for treatment of benign prostate hyperplasia (BPH). While the procedure routinely involves urethral catheter placement, no guidelines exist to inform the duration of catheter use. For these reasons, we formally assessed the appropriateness of different timings for urethral catheter removal after transurethral resection or ablation of the prostate using the RAND/UCLA Appropriateness Method.

Methods

An 11-member expert panel reviewed a summary of the literature on this topic. Using a standardized, multi-round rating process from March through May 2015, the panel rated clinical scenarios for urethral catheter duration as appropriate (i.e., benefits outweigh risks), inappropriate, or of uncertain appropriateness. The appropriateness of various urethral catheter durations was examined across 4 clinical scenarios.

Results

Forty-four articles met inclusion criteria for our study (Figure). Based on our expert panel ratings (Table), urethral catheter removal and first trial of void on postoperative day 1 was appropriate for all scenarios except clinically-significant perforations. In this case, waiting until postoperative day 3 was deemed the earliest appropriate timing. Perforation was the only appropriate indication for waiting ≥7 days after surgery for initial catheter removal and trial of void. Waiting ≥3 days to remove the catheter for patients with or without pre-existing catheter needs, or for those with difficult catheter placement in the operating room, was rated as inappropriate.

Conclusions

We defined clinically-relevant guidance statements for the appropriateness of urethral catheter duration after transurethral prostate surgery. Given the lack of guidelines for catheter duration and this robust expert panel approach, our findings may serve to improve the consistency and quality of care for patients undergoing transurethral surgery for BPH.

Funding

Agency for Healthcare Research & Quality (AHRQ)