LAUSR

Introduction Chronic urinary retention (CUR) is a major problem in elderly patients and leads to high levels of morbidity. CUR can be treated surgically with trans-urethral resection of the prostate (TURP), but surgery is frequently avoided in elderly patients due to increased peri-operative risks and the presence of detrusor activity (DU), which can lead to surgical failure. We report on contemporary outcomes for catheterised elderly patients undergoing TURP from a high-volume university teaching hospital. Patients and Methods Catheterised patients aged 80 years and older undergoing TURP for CUR at a university teaching hospital between 2012 and 2020 (9 years) were eligible. Those with neurogenic bladder, urethral stricture or prior TURP were excluded. Surgical success was defined as being catheter free at 3 month and 12-month follow up. Statistical analysis was performed using the Chi-squared test for grouped data and logistic regression modelling for continuous data. Results 147 patients were included and underwent TURP. Of these, 118 (80.3%) were completely catheter free or using intermittent self-catheterisation (ISC) at initial 3-month follow-up. 117 (79.6%) remained catheter-free at one year follow-up. PVR>1500ml prior to TURP (p=0.017); age ≥90 (p=0.0067); and WHO performance status ≥3 (p< 0.00001) were all identified as independent risk factors for surgical failure. A selected sub-set of patients excluding these risk factors showed overall catheter free rates of 88.8% at 3-month follow-up. Early and late complications were noted in 6.8% and 2.7% of patients. Conclusion Our contemporary series demonstrates high rates of successful post-operative voiding for selected elderly patients after TURP, with catheter free rates at 12 months of 88.8%. Overall complication rate was 9.5%, which may be justified given the alternative morbidity of long-term catheterisation. TURP remains an efficacious and cost-effective treatment for selected elderly patients who are catheterised for CUR.