OBJECTIVESTo evaluate the management of acute urinary retention (AUR) associated with benign prostatic hyperplasia (BPH) in real-life practice.To identify predictors of successful trial without catheter (TWOC).MATERIALS AND METHODSIn all, 6074 men catheterized for painful AUR were enrolled in a prospective, cross-sectional survey conducted in public and private urology practices in France, Asia, Latin America, Algeria and the Middle East.Patient clinical characteristics, type of AUR and its management (type of catheterization, hospitalization, TWOC, use of α1-blockers, immediate or elective surgery) and adverse events observed during the catheterization period were recorded.Predictors of TWOC success were also analysed by multivariate regression analysis with stepwise procedure.RESULTSOf the 6074 men, 4289 (71%) had a spontaneous AUR and 1785 (29%) had a precipitated AUR, mainly as the result of loco-regional/general anaesthesia (28.5%) and excessive alcohol intake (18.2%).Presence of BPH was revealed by AUR in 44% of men. Hospitalization for AUR varied between countries, ranging from 1.7% in Algeria to 100% in France. A urethral catheter was inserted in most cases (89.8%) usually followed by a TWOC (78.0%) after a median of 5 days. Overall TWOC success rate was 61%.Most men (86%) received an α1-blocker (mainly alfuzosin) before catheter removal with consistently higher TWOC success rates, regardless of age and type of AUR. Multivariate regression analysis confirmed that α1-blocker before TWOC doubled the chances of success (odds ratio 1.92, 95% CI 1.52–2.42, P < 0.001).Age ≥70 years, prostate size ≥50 g, severe lower urinary tract symptoms, drained volume at catheterization ≥1000 mL and spontaneous AUR favoured TWOC failure. Catheterization >3 days did not influence TWOC success but was associated with increased morbidity and prolonged hospitalization for adverse events.In the case of TWOC failure, 49% of men were recatheterized and had BPH surgery and 43.5% tried another TWOC with a success rate of 29.5%. Elective surgery was preferred to immediate surgery.CONCLUSIONSTWOC has become a standard practice worldwide for men with BPH and AUR.In most cases, an α1-blocker is prescribed before TWOC and significantly increases the chance of success.Prolonged catheterization is associated with an increased morbidity.

Introduction Elderly men may suffer from late-onset hypogonadism (LOH). The long-term effects of long-acting testosterone undecanoate (TU) in a large number of LOH men have not yet been reported. Aims We analyzed the effects of normalization of plasma testosterone (T) in LOH men. Methods The records of 161 men with LOH (baseline T &lt; 300 ng/dL) were reviewed and 100 men had used parenteral TU for &gt;12 months. The mean duration of treatment was 90.6 weeks (54 to 150 weeks). Main Outcome Measures Body mass index (BMI), waist circumference, percentage body fat, total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides, prostate-specific antigen (PSA), and hematocrit were measured. Further the Aging Male Symptoms’ scale (AMS) and the International Index of Erectile Function (IIEF-5 and 15) were scored. Results T therapy was associated with a significant decline in waist circumference (P = 0.028) and percentage body fat (P &lt; 0.001), but no change of BMI. Total cholesterol and LDL cholesterol declined significantly (P = 0.005 and P = 0.024, respectively), with no significant changes of HDL cholesterol and triglycerides. The scores of sub-scales of AMS (psychological, somotovegetative and sexual factors) decreased (P = 0.044, P = 0.200 and P = 0.071, respectively). The mean IIEF-5 (P = 0.011) and IIEF-15 scores (P = 0.021) improved significantly. Erectile function domain, orgasmic function domain, sexual desire domain, intercourse satisfaction domain, and overall satisfaction domain improved. Median PSA rose from 0.95 (0.640; 1.558) ng/mL to 1.480 (1.015; 2.275) ng/mL (P &lt; 0.001), with 11 patients &gt;4 ng/mL (4.01–13.21). On biopsy there was no evidence for malignancy. The mean hematocrit level increased significantly from 42.3 ± 3.4% to 47.1 ± 3.8%. Conclusions Normalizing serum T in men with LOH resulted in improvement of the metabolic syndrome, mood and sexual functions and appeared acceptably safe.

A prospective, non-randomized, partially blinded, controlled trial was conducted to evaluate the efficacy of irrigation with normal saline solution (NSS) during no-scalpel vasectomy (NSV) compared with NSV alone in 62 men. In the NSS irrigation group, an Angiocath 24-gauge needle was inserted into the distal vas lumen, and 20 mL NSS solution was used to irrigate the vas manually on both sides. Post-operative follow-up included urine samples collected immediately and semen samples for sperm count at 2, 6 and 12 weeks post-vasectomy. The difference in the number of spermatozoa appearing in the post-vasectomy urine samples and the mean urine sperm count in both groups were significantly different ( p < 0.0001 and p < 0.01, respectively). The numbers of post-operative ejaculations, the mean sperm concentration, and the number of patients who achieved sterility (defined as no motile spermatozoa in the ejaculate) in both groups at 2, 6 and 12 weeks were similar ( p > 0.05). It is concluded that although irrigation of the distal vas with NSS was successful in removing a large number of spermatozoa from the tract, this procedure did not significantly accelerate the rate of achieving absence of motile spermatozoa in the ejaculate.