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Abstract：
Objectives: Although previous studies have shown the feasibility of non-intubated techniques, it is unknown whether avoiding urinary catheters can enhance recovery. This study aimed to determine whether the tubeless urinary catheter protocol is feasible and beneficial for minimally invasive lung surgery. Methods: Patients were randomized to the control group, completely tubeless group, and partially tubeless group. A propensity score-matched (PSM) analysis was performed to balance the non-random baseline characteristics. Complications and postoperative recovery were compared. Regression analysis was performed to identify the independent predictors of complications. A nomogram for predicting the risk of non-automatic micturition was constructed and internally validated. Results: One hundred fifty-nine patients were enrolled. The incidence rates of urinary irritation and urinary tract infection (UTI) were significantly lower in the tubeless groups (74.4 vs. 39.5%, p < 0.001; 28.2 vs. 8.6%, p = 0.001, respectively). The tubeless group had a higher proportion of 0-degree discomfort (81.5 vs. 30.8%, p = 0.001) and shorter duration of postoperative hospital stay than the control group (4.59 vs. 5.53 days, p < 0.001). No difference was observed in terms of urination retention and urinary incontinence between the tubeless group and the control group. After PSM, the advantages of the tubeless group still existed, and comparing to the partially tubeless group, the completely tubeless group was of even less UTI and more 0-degree discomfort (18.5 vs. 0.0%, p = 0.019; 96.3 vs. 59.3%, p = 0.002). The tubeless protocol was the only independent protective factor of urinary complications. A nomogram was constructed and showed good predictive ability. Conclusions: The tubeless catheterization protocol led to fewer complications, better compliance, and shorter hospital length of stay. The advantages were more significant with the completely tubeless protocol. The utility of our nomogram can assist clinicians in avoiding risks in performing the tubeless protocol.
摘要：
目标：尽管先前的研究表明了非插管技术的可行性，目前尚不清楚避免使用导尿管是否能促进康复。本研究旨在确定无管导尿管方案对于微创肺部手术是否可行和有益。方法:将患者随机分为对照组,完全无内胎组，和部分无内胎组。进行倾向评分匹配(PSM)分析以平衡非随机基线特征。比较并发症及术后恢复情况。进行回归分析以确定并发症的独立预测因子。构建并内部验证了预测非自动排尿风险的列线图。结果：共纳入59例患者。无管组的泌尿刺激症和尿路感染（UTI）的发生率显着降低（74.4vs.39.5%,p<0.001;28.2vs.8.6%,分别为p=0.001)。无内胎组的0度不适比例较高（81.5vs.30.8%,p=0.001），术后住院时间短于对照组（4.59vs.5.53天,p<0.001)。无内胎组与对照组在排尿潴留和尿失禁方面无差异。PSM之后,无内胎组的优势仍然存在，与部分无内胎组相比，完全无内胎组的UTI更少，0度不适更多(18.5vs.0.0%,p=0.019;96.3vs.59.3%,p=0.002)。无管化方案是泌尿系并发症的唯一独立保护因素。构建了列线图，显示出良好的预测能力。结论：无管化导尿方案导致更少的并发症，更好的合规性，缩短住院时间。完全无内胎方案的优点更为显著。我们的列线图的实用性可以帮助临床医生避免执行无管协议的风险。
