Objective <p>Postoperative bladder spasm is a prevalent complication during the indwelling catheter period after radical prostatectomy (RP), affecting patient recovery and quality of life. This study aimed to identify preoperative patient characteristics that predict bladder spasm during the catheter-indwelling period in discharged patients following RP.</p> Methods <p>A retrospective analysis of 126 patients with localized prostate cancer who underwent RP by a single surgeon between February 2023 and February 2024 was conducted. Preoperative clinical characteristics and pathologic data were collected. The presence of bladder spasm and related symptoms postoperatively was assessed until catheter removal. Univariate and multivariate logistic regression analyses were performed to identify independent predictors for bladder spasm and its manifestations.</p> Results <p>Of the 126 eligible patients, 58 (46.0%) experienced bladder spasm. Higher International Prostate Symptom Score (IPSS) (<i>P</i> = 0.009) and lower educational levels, particularly primary school (<i>P</i> = 0.002) and junior high school (<i>P</i> = 0.044), were significantly associated with bladder spasm in multivariate analyses. Additionally, anxiety was related to a higher odds ratio of catheter-related bladder discomfort (CRBD) (<i>P</i> = 0.016).</p> Conclusion <p>Preoperative factors, particularly higher IPSS, lower educational level, and preoperative anxiety, are significant predictors of bladder spasm and related symptoms following RP. These results highlight the importance of preoperative factors in prediction postoperative complications, informing personalized perioperative care and may assist in the development of targeted interventions to improve patient outcomes and potentially reduce postoperative complications.</p>