Prostate deobstruction surgery is a well-established procedure for lower urinary tract symptoms in men with benign prostatic obstruction. However, some patients experience unsuccessful catheter removal postoperatively. This study aimed to identify clinical and urodynamic predictors of initial trial without catheter failure (TWOC) following prostate deobstruction surgery.

This retrospective cohort study included 322 patients undergoing transurethral resection of the prostate, GreenLight laser photoselective vaporization, or holmium laser enucleation of the prostate between 2018 and 2024. Urodynamic studies assessed detrusor pressure at maximum flow (PdetQmax), bladder contractility index (BCI), bladder outlet obstruction index (BOOI), and post-void residual volume (PVR). Detrusor underactivity (DU) was defined as BCI < 100, while bladder outlet obstruction (BOO) severity was categorized by BOOI (≥40: high BOO, 20-40: equivocal BOO, <20: low BOO). TWOC failure was defined as recatheterization within one week. Logistic regression identified independent predictors.

The TWOC failure rate was 12.1%. Patients with TWOC failure had lower PdetQmax (P = 0.022), lower BCI (P = 0.007), and higher PVR (P = 0.017). Multivariate analysis identified DU (OR: 2.77, P = 0.012) and low BOO (OR: 2.88, P = 0.041) were independently associated with TWOC failure. Notably, patients presenting with both risk factors exhibited a higher likelihood of TWOC failure (OR 4.56; P = 0.003). In contrast, patients with no DU and high BOO had a lower likelihood of TWOC failure (OR: 0.32, P = 0.003). Among patients with preoperative PVR ≥ 300 mL, those with no DU and high BOO consistently had a reduced risk of TWOC failure (OR: 0.11, P = 0.041).

Preoperative urodynamic improve TWOC failure risk stratification post-prostate deobstruction. Careful catheter removal is needed for patients with DU and low BOO. In contrast, early removal may be feasible for high BOO with no DU, even in the presence of high PVR.