Transurethral versus Suprapubic Catheterization in Acute Bacterial Prostatitis: Clinical Predictors and Outcomes.

INTRODUCTION: Acute bacterial prostatitis (ABP) is a common complication in men with lower urinary tract symptoms (LUTS). While antibiotics are the mainstay of treatment, the choice between transurethral (TC) and suprapubic (SC) catheterization remains debated. This study aimed to identify factors influencing catheterization choice and its impact on clinical outcomes. METHODS: We retrospectively analyzed 255 patients presenting with ABP between 01/2015 and 12/2024. Clinical- and infection-related parameters, including prostate volume, post-void residual urine (PVR), CRP levels, and presence of prostatic abscess, were assessed for associations with catheter type. We further evaluated these factors and catheterization approach regarding hospital stay, need for subsequent subvesical de-obstruction, and 30-day readmission rates. RESULTS: Median age was 64 years, median prostate volume 52 cc. Most patients received SC (64.3%). PVR was less frequent in the TC group (21.8% vs. 34.6%, p=0.042), while high CRP was more common (68.1% vs. 54.9%, p=0.039). Prostatic abscesses occurred more often in SC patients (8.6% vs. 3.4%, p=0.119). Median hospital stay was comparable (5 days, respectively, p=0.676). TC patients had lower 30-day readmission rates (1.1% vs. 6.8%, p=0.045), whereas SC patients more frequently required subvesical de-obstruction during follow-up through 12/2024 (21.3% vs. 11.0%, p=0.038). CONCLUSION: SC was preferred in patients with high PVR and abscesses. TC was associated with fewer readmissions, whereas SC patients more often required subsequent subvesical de-obstruction. These findings highlight the need for prospective studies to optimize catheterization strategies in ABP.