Abstract / Summary
Abstract Background Catheter-related bladder discomfort (CRBD) is a common and distressing complication following transurethral resection of the prostate (TURP). Dexmedetomidine has been shown to reduce CRBD; however, its effectiveness under a targeted low-dose infusion strategy in routine clinical practice remains unclear. This study aimed to evaluate the impact of dexmedetomidine on CRBD and emergence profile in patients undergoing TURP. Methods In this retrospective cohort study, patients undergoing TURP were categorized into control and dexmedetomidine groups. The primary outcome was CRBD incidence and severity during early postoperative recovery. Secondary outcomes included emergence agitation assessed by the Richmond Agitation–Sedation Scale (RASS) and perioperative safety outcomes. Inverse probability of treatment weighting (IPTW) was applied to adjust for baseline differences. Results Among 754 patients with available postoperative CRBD assessment (control, n = 491; dexmedetomidine, n = 263), perioperative low-dose dexmedetomidine significantly reduced the incidence of CRBD (65.8% vs. 73.5%; P = 0.026), overall CRBD severity (0.92 ± 0.79 vs. 1.12 ± 0.82, P = 0.001), and moderate-to-severe CRBD (24.7% vs. 36.3%, P = 0.001). The overall CRBD severity distribution also shifted toward milder grades (P = 0.010). As a secondary outcome, dexmedetomidine reduced the incidence of emergence agitation (RASS ≥ + 1) (8.0% vs. 17.3%, P < 0.001), although the mean RASS score did not differ significantly between groups (P = 0.061). After inverse probability of treatment weighting, dexmedetomidine remained associated with lower CRBD incidence (absolute risk reduction [ARR], − 7.9%; P = 0.027), reduced CRBD severity (average treatment effect [ATE], − 0.20 grades; P < 0.001), lower moderate-to-severe CRBD (ARR, − 11.6%; P < 0.001), and reduced emergence agitation (ARR, − 8.1%; P < 0.001). Conclusions Targeted low-dose dexmedetomidine infusion was associated with reduced catheter-related bladder discomfort and improved emergence profile without increasing hemodynamic adverse events in patients undergoing TURP. These associations remained significant after inverse probability of treatment weighting.