Factors Affecting Trial Without Catheter for First Spontaneous Acute Urinary Retention

Abstract

PurposeTo find the association of trial without catheter (TWOC) outcome for first spontaneous acute urinary retention (AUR) in benign prostatic obstruction with age, prior lower urinary tract symptoms (LUTS), retention volume at catheterization (RV), and size of prostate.MethodsOur prospective observational analytical (interventional) study enrolled 77 cases of spontaneous AUR over 24 months. After clinical evaluation, digital rectal examination, and transabdominal ultrasonography, all patients were catheterized per urethra and their RV was recorded. TWOC was administered after 2 or 3 doses of 0.4 mg tamsulosin-oral absorption control system and after 48-72 hours had passed. A successful endpoint was defined as a maximum flow-rate, >5 mL/sec; voided volume, >100 mL; postvoid residue, <200 mL; and voiding within 6 hours of catheter removal. Data obtained from 58 patients were analyzed after excluding the cases lost to follow-up and secondary exclusion. Age, RV, duration of LUTS, and prostate volume on examination and ultrasonography (PUSG) were recorded and statistically analyzed. Prostate-specific antigen levels were obtained on follow-up and cases of cancer, as seen on transrectal ultrasound-guided biopsy, were secondarily excluded.ResultsThe patients had a mean age of 65.89±8.67 years. Prior LUTS was seen in 35 patients (2.07±2.91 months). The mean PUSG and RV were 46.81±20.58 mL and 854.8±36.26 mL, respectively. Thirty patients underwent a successful TWOC; a mean age of 63.13±8.58 years (mean±standard deviation; unpaired t-test; P=0.0053) and a PUSG of ≤45 mL (Pearson chi-square test; P=0.0427) were significantly associated with a successful outcome.ConclusionsThere is a significant association between TWOC outcome, age (P=0.0053), and PUSG (P=0.0427).

Terazosin versus Alfuzosin in Treatment of Acute Urinary Retention in Patients with Benign Prostatic Hypertroph

“…T h i s i s compatible with the findings of previous related studies. 6,7 Our TWOC rate for alfuzosin (57.1%) was comparable to that of a larger scale study conducted by McNeil et al 8 Mahadik et al 9 demonstrated strong association between age, prostate size on ultrasound and TWOC outcome. Contrary to their findings, we did not find significant association between age and prostate size in fingerbreadth with TWOC rate.…”

Predictors of successful trial with-out catheter following acute urinary retention secondary to benign prostatic hypertrophy

“…12,13 On the contrary Mahadik, Zeif and Lim et al in their studies of 58, 100 and 79 patients each found RUV to be a statistically insignificant parameter (mean RUV of 850 ml, 750 ml and 800 ml respectively). 11,14,15 PV was not found to be a parameter of statistical significance in our study. Literature is divided with respect to this.…”

Hydronephrosis Predicts Successful Catheter Removal after Painful Urinary Retention - Preliminary Results of a Prospective Single Center Study

“…Several studies investigating factors for successful catheter removal found prostate volume and age as significant predictors for successful catheter removal [9,18,20,22,23]. In the present study, predictive value for these parameters was also high.…”

“…Most of the other studies did not define a residual volume cutoff when assessing successful catheter removal. Only Mahadik et al [20] characterized a successful catheter removal when residual urine volume was <200 ml. In our opinion, it has to be considered that consistent high residual urine volumes have the risk of other urological complications like urinary tract infections or chronic hydronephrosis leading to loss of kidney function.…”