Introduction Acute urinary retention (AUR) is a common urological presentation to emergency departments (ED). An ambulatory care protocol had been developed allowing trial without catheterization (TWOC) instead of admission to hospital after catheterization in the ED. This study aimed to evaluate the efficacy of the ambulatory care protocol for patients with AUR. The secondary aim was to identify any independent predictor(s) for successful weaning of urinary catheter in a short duration. Methods This was a prospective cohort study. A total of 143 male patients presenting with an episode of AUR underwent urinary catheterization once. Those who were unable to pass urine afterwards were catheterized again and discharged home with a urinary catheter in-situ (Day 0). On Day 3, ability of spontaneous urination was assessed. If failed, spontaneous urination was assessed again on Day 6. Results Successful TWOC was recorded in 50.3% of the 143 patients after first catheterization. The cumulative successful rates for first (Day 3) and second (Day 6) follow-ups were 76.9% and 79.0%, respectively. Among the associated predictors, only the urine retention volume on first catheterization was found to be independently associated with successful TWOC, using binary logistic regression (p=0.001). Conclusion The ambulatory care protocol was successful in weaning off urinary catheter for 50.3% of patients with AUR after first catheterization and a further 26.6% on Day 3, making a cumulative success rate of 76.9%. Those who failed TWOC on Day 3 would get little benefit on further trials. The first catheterization volume was independently associated with the chance of successful TWOC.

Objective Stroke patients often came late to hospital and arrived beyond the therapeutic time window for thrombolytic therapy. We studied the time from stroke onset to arrival at Accident and Emergency (A&E) department and examined what barred them from early medical attendance. Methods All acute stroke patients attending A&E between 15 March 1999 to 14 June 1999 were recruited. For those brought in by ambulance, their time intervals were divided into three: phase I was between stroke onset to call 999; phase II was between call 999 to A&E arrival; and phase III was between A&E arrival to being seen by doctor. For those who did not come by ambulance, they were divided into two groups: those who consulted other doctors and those who did not consult other doctors before coming to A&E. Their time lags from stroke onset to A&E consultation were compared. Results One hundred and fifteen stroke patients were consecutively recruited. Sixty-five ambulance users had median time for phase I as 151 minutes, for phase II as 32 minutes, for phase III as 17 minutes. The total median time lag was 190 minutes. Fifty were ambulance non-users. For those who did not consult other doctors before A&E attendance, the median time lag was 641 minutes. For those who consulted others doctors before A&E attendance, their median time lag was 3,672 minutes. As a group their median time lag was 950 minutes. For the 65 ambulance users, we further studied the time intervals between A&E arrival and being seen by doctors; and the median waiting time for doctors was 17 (range 0 to 60) minutes. Conclusions Public education was of paramount importance. Some common stroke signs could be widely propagated for recognition. Phase I should be less than 80 minutes. The median time for phase II would likely remain to be 32 minutes. Further shortening could be achieved in phase III. As category III & IV patients were most likely potential candidates for thrombolysis, they should be seen within 15 minutes. This would leave only 53 minutes for clinical assessment, CT brain and preparation of thrombolytic agent. These measures could increase the chance of providing thrombolytic treatment within the therapeutic time window.