Why is Ibuprofen given after TURP for TWOC?

Ibuprofen After TURP for TWOC: Pain Management to Improve Voiding Success

Ibuprofen is given after TURP before trial without catheter (TWOC) to reduce bladder irritation and pain, which improves the success rate of spontaneous voiding by decreasing inflammation and bladder spasm.

Mechanism and Benefits of Ibuprofen Post-TURP

Ibuprofen provides several important benefits for patients undergoing TWOC after TURP:

1. Anti-inflammatory effects:

   • Reduces prostatic and urethral inflammation caused by surgical trauma
   • Decreases bladder irritability that can impair normal voiding

2. Pain management:

   • Controls post-operative pain that might otherwise inhibit normal voiding reflexes
   • Reduces bladder spasms that can interfere with coordinated micturition

3. Improved patient comfort:

   • Allows for more relaxed voiding attempt during TWOC
   • Reduces anxiety associated with catheter removal

Factors Affecting TWOC Success After TURP

The success of TWOC after TURP depends on multiple factors:

• Age: Patients over 70 years have decreased TWOC success rates 1
• Prostatic volume: Volumes exceeding 50 ml are associated with decreased TWOC efficacy 1
• Catheterization duration: 3-7 days of catheterization shows highest success rates for spontaneous voiding 1
• Mode of presentation: Patients with acute retention have a 10% failure rate to void after TWOC, while those with chronic retention have a 38% failure rate 2

Optimal Management Protocol

For best outcomes in TWOC after TURP:

1. Medication regimen:

   • Administer ibuprofen for pain control and anti-inflammatory effects
   • Add alpha-blockers (e.g., alfuzosin) for at least three days prior to TWOC to improve success rates (60-62% vs 34-48% with placebo) 3

2. Timing considerations:

   • Maintain catheter for 3-7 days post-TURP for optimal TWOC success 1
   • Schedule TWOC when pain management is optimal (typically 30-60 minutes after ibuprofen administration)

3. Patient preparation:

   • Ensure adequate hydration before TWOC
   • Position patient comfortably for voiding attempt
   • Consider privacy and relaxed environment to reduce anxiety

Common Pitfalls and Caveats

• Failure to recognize high-risk patients: Patients with chronic retention or acute-on-chronic retention have significantly higher failure rates (38-44%) compared to those with acute retention (10%) 2

• Inadequate pain control: Insufficient management of post-operative pain can lead to failed voiding attempts due to guarding and inability to relax pelvic floor muscles

• Overreliance on medications alone: While medications improve TWOC success, they should be part of a comprehensive approach that includes appropriate catheterization duration and patient preparation

• Ignoring residual volumes: High residual volumes at presentation should not preclude TURP, as increasing residual volume does not significantly reduce the likelihood of successful TURP 4

By addressing these factors and ensuring adequate pain management with ibuprofen, clinicians can optimize the chances of successful TWOC after TURP, improving patient outcomes and quality of life.