Urinary Catheter Management After Aquablation
The urinary catheter should typically remain in place for 1-2 days after aquablation procedure for benign prostatic hyperplasia, with most patients having their catheter removed on postoperative day 1.
Evidence for Catheter Duration After Aquablation
Early clinical studies on aquablation provide the most direct evidence for catheter management following this specific procedure:
- In the first-in-man study by Gilling et al., all but one patient had their catheter removed on day 1 post-aquablation, with most patients discharged on the first postoperative day 1
- In a prospective multicenter trial, 19 out of 21 patients (90.5%) were discharged home the day after the procedure, with catheterization typically lasting only 1 day 2
General Principles of Postoperative Catheter Management
While specific guidelines for aquablation catheter management are limited, several general principles apply:
- The American College of Surgeons recommends removing urinary catheters within 24 hours after major surgery in most patients to reduce UTI risk 3
- Extended catheterization beyond 2 days is associated with:
Considerations for Catheter Removal
Factors supporting early catheter removal:
- Reduced risk of catheter-associated UTI (CAUTI) 5, 3
- Earlier mobilization and shorter hospital stay 3
- Prevention of catheter-related complications including delirium in older adults 3
Potential reasons for extended catheterization:
- Patients with significant bleeding requiring bladder irrigation
- Patients with urinary retention risk factors (large prostate, severe symptoms pre-procedure)
- Ongoing sepsis or need for strict fluid monitoring 3
Post-Removal Monitoring
After catheter removal:
- Monitor for successful voiding within 6-8 hours
- Check for signs of urinary retention (inability to void, bladder distension)
- Consider bladder ultrasound if retention is suspected
- Implement scheduled voiding every 2-4 hours initially 3
Management of Retention After Catheter Removal
If urinary retention occurs after catheter removal:
- Consider single in-out catheterization before reinserting an indwelling catheter 3
- Alpha-blocker therapy may be beneficial before next catheter removal attempt in males 3
Conclusion
Based on the available evidence, most patients undergoing aquablation should have their urinary catheter removed on postoperative day 1. This approach balances the need for adequate postoperative monitoring while minimizing the risk of catheter-associated complications.