Introduction & Objective :
Treatment of benign prostatic hyperplasia (BPH) using Greenlight photovaporization of the prostate (PVP) has emerged as a popular minimally invasive alternative to transurethral resection of the prostate. In this study, we aim to review our experience with PVP to determine the risk factors for failing a void trial in the early post-operative period, which we define as postoperative day 0 or 1 (POD 0/1).
A retrospective chart review was performed on all consecutive patients who underwent PVP at a single institution from 2010 to 2016. Categorical data were represented using percentages and compared using chi-squared test. Continuous data were represented as means and compared using t-test. Data were analyzed using Graph Pad Prism Software. Differences between the two groups were considered statistically significant if P<0.05.
A total of 204 consecutive PVP were performed between 2010 and 2016. A void trial was attempted on 172 patients within 24 hours of the procedure. A total of 126 of 172 (73.26%) patients passed a void trial on POD 0/1. A Foley catheter was in place at the time of surgery in 67 patients, of which 46.27% went on to fail their void trial compared to only 14.29% of those with no preoperative Foley catheter (p<0.001). Patient age also appeared to have a negative correlation with passing void trial. The mean age of those who went on to pass their void was 69.67 compared to 74.13 in those who failed (p = 0.0072). Having a preoperative Foley catheter was also associated with a longer operative times (68.35 vs 79.64 minutes, p=0.002) and length of stay (LOS), 1.51 vs 0.91 days, p=0.026. There was a total of 47 patients with a diagnosis of diabetes, of which 79.72% passed their void trial compared to 70.63% who did not have diabetes (p=0.2887).
Predictors for failing an early void trial following Greenlight PVP include patients with a preoperative Foley catheter and older age. Patients who failed their void trial had a significantly longer LOS. Having a diagnosis of diabetes mellitus did not appear to increase risk of failing void trial as previously reported. Urologists must balance the risk of leaving a catheter in place for longer than necessary versus removing it too early requiring replacement, which is distressful to some patients. Since patients with preoperative foley catheters are at high risk for failing an early postoperative void trial, it would decrease hospital LOS and the number of patients requiring catheter reinsertion if these patients are sent home on POD 0 with foley catheter in place and deferring void trial to a later date. Patients with low risk of failing should have a void trial on POD 0/1.
Rush University Medical Center
Edward Capoccia, MD, Rush Urology Medical Center. I am currently a PGY4 with an interest in endourology fellowship.