Abstract

Objective: To evaluate the early and long-term clinical outcomes of bipolar transurethral resection of the prostate (B-TURP) surgery in patients with prolonged preoperative urethral catheterization due to their operations being postponed during the COVID-19 pandemic.
Materials and Methods: Patients with benign prostatic hyperplasia (BPH) whose B-TURP procedures were delayed due to the COVID-19 pandemic were analyzed. The patients were divided into two groups: Patients awaiting surgery without a catheter were defined as Group A, while those who developed acute urinary retention (AUR) and were catheterized were defined as Group B. Preoperative and postoperative International Prostate Symptom Score (IPSS) values, IPSS subscores (voiding and storage), early and long-term clinical outcomes, and complications were compared.
Results: Group A included 53 patients who were operated on without a catheter, and Group B included 68 patients who waited for surgery with a catheter in place for an average of 89.6 days. No statistically significant differences were found between Group A and Group B in terms of age, body mass index, IPSS, American Society of Anesthesiologists score, length of hospital stay, or total follow-up duration (p > 0.05). However, Group B had significantly higher prostate-specific antigen levels, prostate volume, operative time, specimen weight, and perioperative catheterization time compared to Group A (p < 0.01). While total IPSS scores were similar between the groups, Group B exhibited significantly higher IPSS voiding scores but significantly lower IPSS storage scores compared to Group A (p < 0.001). When assessing the IPSS voiding-to-storage (V/S) ratio, both the 12-month and long-term values were significantly higher in Group B than in Group A (p < 0.001).
In both univariate and subsequent multivariate analyses comparing patients with an IPSS V/S ratio of 1 or less and those with a ratio of ≥1 at 12 months, no significant difference was observed in mean ages between the two groups (p = 0.101). However, patients with an IPSS V/S ratio of ≥1 had significantly more frequent perioperative catheterizations, longer operative times, and lower resection rates (p < 0.001, p = 0.009, and p < 0.001, respectively). Multivariate logistic regression analysis showed that perioperative catheterization was an independent risk factor for predicting an IPSS V/S ratio of ≥1. After adjusting for all potential confounding factors, perioperative catheterization significantly increased the odds of an IPSS V/S ratio exceeding 1 (odds ratio = 97.135, 95% confidence interval: 22.713–415.416, p < 0.001).
Conclusions: In patients who developed AUR due to BPH during the COVID-19 pandemic, the postponement of elective surgeries and the requirement for prolonged catheterization resulted in functional impairments in voiding symptoms following B-TURP surgery.

Key words: Benign prostatic hyperplasia, Bipolar transurethral resection of the prostate, COVID-19, Lower urinary tract symptoms, Voiding symptoms, Storage symptoms.