Men’s Urology Catheter-Free Program

The Problem: Benign Prostatic Hyperplasia and Acute Urinary Retention

Benign prostatic hyperplasia (BPH) is a benign, or noncancerous, condition where the prostate gland becomes enlarged. When the prostate grows larger, it can press on nearby tissues and block the flow of urine. BPH mainly affects older men, and the incidence increases with age. In the U.S.:

• About 70% of men ages 60–69 have BPH.
• More than 80% of men over age 70 have BPH.

BPH can cause a number of bothersome urinary symptoms, up to and including including urinary retention. Urinary retention can develop slowly over time (chronic) or happen suddenly (acute). Acute urinary retention (AUR) – a sudden, painful inability to urinate – requires emergency medical care. AUR can also lead to:

• Decreased quality of life.
• Urinary tract infections (UTIs).
• Blood in the urine (hematuria).

In the U.S., the number of men with BPH who develop AUR is on the rise. About 10% of these patients need hospital care and catheter use. Each year:

• Around 1,500 men in Cuyahoga County experience AUR caused by BPH.
• About 3,000 men across eight counties (Cuyahoga, Lake, Lorain, Summit, Portage, Ashland, Ashtabula, and Geauga) experience AUR caused by BPH.

The risk of developing AUR increases as men get older and as BPH becomes more severe.

Why Does Catheter Dependence Occur?

Men who receive a catheter for AUR may keep it longer than needed because of:

• Delays in receiving medical evaluations.
• Slow specialist referral processes.
• Lack of clear timelines for safely removing catheters.

Why Is Catheter Dependence Harmful?

Catheter dependence can lead to:

• Decreased quality of life.
• Urinary tract infections (UTIs).
• Urethritis (inflammation of the urethra’s external opening).
• Erosion (tearing) of the urethra.
• Scar tissue that narrows the urethra (urethral strictures).
• Bladder spasms and bladder stones.
• Sepsis (a life-threatening reaction to infection) and sepsis-associated death.

Program Goals

The Men’s Urology Catheter-Free Program aims to improve care for men with AUR by:

• Reducing long-term catheter use.
• Lowering catheter-associated infections, sepsis and related deaths.
• Helping patients receive medications, bladder scans and urology referrals sooner.
• Increasing access to Holmium Laser Enucleation of the Prostate (HoLEP) procedures.

HoLEP is a minimally invasive treatment for BPH. During this procedure, a laser removes the inner part of the prostate that blocks urine flow. HoLEP is the gold standard for resolving BPH-related urinary retention, is associated with a very low complication rate, allows for faster recovery and does not require surgical incisions.