Early Versus Delayed Catheter Removal After Bipolar TURP: A Prospective Randomized Study with Long-Term Functional Follow-up.

OBJECTIVE: To compare early (24-hour) versus delayed (72-hour) urethral catheter removal after transurethral resection of the prostate (TURP), focusing primarily on postoperative functional outcomes and secondarily on hospitalization, complications, and treatment cost. METHODS: This prospective, single-center randomized study included 88 men undergoing bipolar TURP for benign prostatic obstruction between February 2022 and June 2025. Patients were randomized to early catheter removal at 24 hours (n = 43) or delayed removal at 72 hours (n = 45). Primary outcomes were functional parameters, including maximum urinary flow rate (Qmax), postvoid residual urine volume (PVR), and International Prostate Symptom Score (IPSS), assessed immediately after catheter removal, at the third postoperative month, and at final follow-up. The median duration of follow-up was 20.5 months. Secondary outcomes included length of hospitalization, need for secondary treatment or intervention, and total treatment cost. RESULTS: Baseline characteristics were comparable between groups. Immediately after catheter removal, Qmax values were similar between groups (p = 0.851). Post-catheter IPSS scores were slightly higher in the early group but remained within the mild symptom range (p = 0.031). At the third postoperative month and at final follow-up, no significant differences were observed between groups in Qmax, PVR, or IPSS (all p > 0.05). The median cost excluding the TURP procedure fee was lower in the early group (65 vs. 87 USD, p = 0.016), as was the median total cost including the TURP procedure fee (240 vs. 296 USD, p = 0.012). Rates of secondary treatment or additional intervention were similar between groups (14.0% vs. 13.3%, p = 0.932). CONCLUSION: Early catheter removal 24 hours after bipolar TURP does not adversely affect short- or long-term functional outcomes and is associated with shorter hospitalization and lower treatment cost without increasing complication rates. These findings support early catheter removal as a safe and efficient strategy in contemporary bipolar TURP practice.