Last updated: March 2026
If you are reading this with a urinary catheter in place, I understand what you are going through. The catheter is uncomfortable, it restricts your mobility, you worry about infections, and every passing day feels like your life is on hold. Perhaps you have been told to wait, that you will be placed on a waiting list, or that your prostate is too large for endoscopic surgery.
I want you to know something important: the catheter can be removed. In the vast majority of cases, HoLEP can resolve the obstruction definitively and restore the patient's ability to urinate normally, even after months or years of catheterisation.
Why is a permanent catheter placed?
A permanent urinary catheter is placed when a patient cannot urinate on his own — what we call urinary retention. This happens when the prostate has grown to a point where it completely blocks the outflow of urine. Sometimes it occurs acutely (from one day to the next, often after a heavy meal, a long journey, or a cold), and sometimes it is the end point of progressive deterioration.
In A&E, the catheter is placed as an emergency measure. The problem is that, afterwards, the patient can remain in limbo: an attempt is made to remove the catheter with medication (alpha-blockers), and if it fails, the catheter is replaced. And so it continues — weeks or months with a catheter, waiting for a surgical solution that sometimes takes far too long to arrive.
What the catheter does to your quality of life
You do not need me to explain this — you live it every day. But it is worth naming the consequences to underscore the urgency of resolving the situation:
- Recurrent urinary infections — every catheter change carries a risk of infection.
- Constant discomfort, urethral irritation, bladder spasms.
- Limitations on travel, exercise, and normal daily activities.
- Psychological impact: loss of independence, embarrassment, social withdrawal.
- Risk of urethral damage from prolonged catheterisation.
Can the catheter be removed permanently?
Yes. In the vast majority of cases, yes.
HoLEP removes all the prostatic tissue causing the obstruction, regardless of its size. By eliminating the cause of the retention, urine can flow freely again. In our experience, patients who were catheterised before surgery are the ones who experience the most dramatic change in quality of life — they go from depending on a catheter to urinating normally, often with a flow rate better than anything they had experienced in years.
It does not matter if your prostate weighs 80, 120, or 200 grams. It does not matter if you have been catheterised for weeks or months. What matters is that the bladder still has the ability to contract — and this is something we can assess before surgery.
The surgical challenge of the catheterised patient
I must be honest: operating on a patient who has been catheterised for a long time is not exactly the same as operating on someone who walks in from the outpatient clinic. There are specific considerations that must be managed carefully.
Infection and sepsis
The catheterised patient almost always has bacteria in the urine — it is virtually inevitable with a foreign body permanently in the urinary tract. If not managed properly, surgical manipulation can cause bacteraemia or, in the worst case, sepsis.
This is a risk I take extremely seriously. At ICUA, we have developed a rigorous preventive protocol: we change the catheter in clinic days before surgery and send the tip to the laboratory for culture. We begin targeted antibiotic therapy based on the sensitivity pattern at least 4 days before the operation. If the organisms are multidrug-resistant and there are no oral options, we admit the patient for intravenous antibiotics beforehand. Applying this protocol, we have not seen cases of postoperative sepsis.
The deteriorated bladder
This is the factor that most influences the final result. A bladder that has spent years fighting against obstruction can lose its ability to contract. If the bladder can no longer push, removing the obstruction will not restore normal voiding — the patient may be left with high residual volumes or may even need intermittent self-catheterisation.
The good news is that many bladders that appear "exhausted" recover some of their function after surgery, sometimes surprisingly so. A study involving 50,000 subjects demonstrated that bladder deterioration is progressive but that a window of opportunity exists before the damage becomes irreversible. This is why I insist that every month with a catheter is a month of potential additional bladder damage.
Raised PSA in the catheterised patient
Often, the catheterised patient has an elevated PSA. This may be due to prostate size, inflammation from the catheter, or — occasionally — an underlying prostate cancer. It is essential to rule out cancer before performing an enucleation.
At ICUA, we have developed a rapid resolution protocol for these patients: we perform a transperineal biopsy under spinal anaesthesia as an outpatient procedure, using our MRI-fusion and micro-ultrasound protocol. Our pathologist processes the samples overnight and has the result ready first thing the following morning.
If the biopsy is negative, the patient is readmitted that same day and we proceed with HoLEP. In this way, a process that at other centres can take weeks is resolved in two days. For the catheterised patient, who lives every day as an ordeal, this speed makes an enormous difference.
Act now: time is not on your side
I will be direct: if you have a permanent catheter due to prostatic obstruction, every week that passes without resolving the situation is a week of potential additional bladder deterioration. The bladder does not wait indefinitely. The sooner the obstruction is resolved, the greater the chance that the bladder will recover its function.
I have seen too many patients who arrived too late — men in their 80s who had been catheterised for years and whose bladder could no longer contract. We removed the entire adenoma, the urethra was completely clear, but the bladder simply would not push. It is a sad situation and, in many cases, one that was avoidable had action been taken sooner.
Send us your medical records. We respond within 48 hours with an initial assessment and an action plan.
📞 +34 91 435 28 44 · ✉ icua@icua.es
Scientific references
- Iscaife A, Rodríguez Socarrás M, Talizin TB, et al. Contemporary results of En Bloc HoLEP for large prostates. World J Urol. 2025;43:401. PubMed
- Gauhar V, Gómez Sancha F, Enikeev D, et al. Results from a global multicenter registry of 6193 patients (REAP). World J Urol. 2023;41:3033-3040. PubMed
- Tricard T, Xia M, Trambert C, et al. Open prostatectomy is dead — long live endoscopic enucleation of the prostate! World J Urol. 2023;41:1457-1463. DOI
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