Best nonsurgical managements of acute urinary retention: what's new?

Abstract

Purpose of reviewTo provide a comprehensive review of the nonsurgical management of acute urinary retention (AUR). Recent findingsA recent meta-analysis confirmed that a-blockers are associated with higher rates of successful trial without catheter (TWOC) compared with placebo, while combination therapies do not significantly reduce the rate of recatheterization. Compared with standard TWOC, bladder perfusion with physiological serum prior to catheter removal is a simple and cost-effective method to increase TWOC success rates (odds ratio 2.41, 95% confidence interval 1.53-3.8), and to reduce time-to-discharge (À89.68 min, 95% confidence interval À160.55, À18.88). Clean intermittent catheterization (CIC) is increasingly used for urinary retention in patients with benign prostatic hyperplasia as existing data suggest that it may decrease the risk of urinary tract infections, accelerate spontaneous voiding recovery and might be more cost-effective compared with indwelling urethral catheterization. Ongoing trials are examining whether office-placed prostate stent may be a promising solution in patients with AUR.

Comparing effects of alpha-blocker management on acute urinary retention secondary to benign prostatic hyperplasia: A systematic review and network meta-analysis

“… 22 Several alpha blockers that have been tested in patients with AUR have been shown to increase the rates of successful TWOC. 23 A recent meta-analysis showed that, compared to placebo, most alpha blockers provided significantly higher rates of successful TWOC, including alfuzosin (OR: 2.28, 95% CI: 1.55–3.36), silodosin (OR: 5.68, 95% CI: 1.84–17.5), and tamsulosin (OR: 2.40, 95% CI: 1.29–4.45), but not doxazosin (OR: 1.22, 95% CI: 0.38–3.93). 20 The duration of providing alpha blocker before TWOC remains under discussion.…”

“…Thus, increasing the duration of alpha blocker prior to TWOC seems to provide no significant benefit, with the level of evidence about this point remaining low. 23 …”

Efficacy and safety of the Rezum system for the treatment of catheter‐dependent urinary retention: Three‐year real‐world outcomes in a multimorbid, multiethnic population

“…Urinary retention secondary to benign prostate hyperplasia (BPH) is a challenging yet not uncommon issue faced among the geriatric population, with more than 10% of men in their 70s estimated to be diagnosed with urinary retention. 1 Once diagnosed, these patients become catheter-dependent, and their quality of life consequently suffers. Additionally, they become at risk for catheter-associated complications such as urinary tract infections (UTI), urethral bleeding, hematuria, urethral stricture, and physical discomfort.…”

“…Urinary retention secondary to benign prostate hyperplasia (BPH) is a challenging yet not uncommon issue faced among the geriatric population, with more than 10% of men in their 70s estimated to be diagnosed with urinary retention 1 . Once diagnosed, these patients become catheter‐dependent, and their quality of life consequently suffers.…”

Exime Temporary Prostatic Stent: A New Alternative to Indwelling Urethral Catheters

“…The immediate management of benign prostatic obstruction (BPO)-related acute urinary retention (AUR) involves insertion of an indwelling urethral catheter (IUC) or suprapubic catheter, followed by a trial without catheter (TWOC) [1] . In cases of TWOC failure, urethral recatheterization should be avoided, as it is associated with time-dependent complications and patient discomfort [2] , [3] .…”