Intravesical Prostatic Protrusion Predicts the Outcome of a Trial Without Catheter Following Acute Urine Retention

Tan, Yeh Hong; Foo, Keong Tatt

doi:10.1097/01.ju.0000095474.86981.00

Cited by 98 publications

(91 citation statements)

References 6 publications

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“…These include the volume drained [4][5][6] , age [6] , PSA [5] , intravesical prostatic protrusion [7] , urodynamic studies [6,8] and prostate size [3] . In this series, we have successfully been able to demonstrate 3 predictive values that will help in the future management of AUR.…”

Section: Discussionmentioning

confidence: 99%

Management Outcome of Acute Urinary Retention

et al. 2009

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Objectives: To assess for predictors of outcome in patients presenting with acute urinary retention (AUR). Methods: A study was performed in our unit to evaluate trial without catheter (TWOC) and successive management. We assessed for predictors of surgical or medical management, which included: age, volume drained at time of catheterisation, cause of retention, serum creatinine, success of trial of voiding, co-morbidities, prostate-specific antigen (PSA) and prostate size on digital rectal examination (DRE). Results: 72 men were entered into the study over an 18-month period: 27 had a successful first TWOC, 20 patients had a second TWOC, and 6 were successful. In total, 31 of the 33 patients with a successful TWOC remained on α-blockers without a further episode of AUR within a minimum of 6 months’ follow-up. Patients failing TWOC were managed by transurethral resection of the prostate (n = 22), long-term catheterisation (n = 15) or prostatic stents (n = 3), and 1 patient died prior to intervention. Three predictors were significant on multivariate analysis: PSA (>2.9 ng/ml), prostate size on DRE (large) and volume drained at time of catheterisation (≥1,000 ml). Conclusion: Patients with elevated PSA (>2.9 ng/ml), a large prostate size on DRE and a volume drained at time of catheterisation >1,000 ml are best managed by surgical intervention, while those with volumes drained at time of catheterisation of <1,000 ml, a PSA ≤2.9 ng/ml, and moderate to small prostate on DRE may be managed medically.

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Section: Discussionmentioning

confidence: 99%

Management Outcome of Acute Urinary Retention

et al. 2009

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“…Increasing age and urinary retention volume were shown to be associated with increased risk of failed TWOC outcome [10] , but were not important in this study. Our study showed that constipation and prostatic symptoms measured by IPSS score were significant fac- [13,14] , serum PSA [16] and IPP grading [17] or measurement [18] were shown in other studies to be important predictors of failed TWOC after AUR. In particular, patients with IPP grade 3 ( 1 10 mm) on transabdominal ultrasound and who were Alfuzosin naïve were shown to have almost 70% chance of failure of TWOC [17] .…”

Section: Discussionmentioning

confidence: 72%

“…Our study showed that constipation and prostatic symptoms measured by IPSS score were significant fac- [13,14] , serum PSA [16] and IPP grading [17] or measurement [18] were shown in other studies to be important predictors of failed TWOC after AUR. In particular, patients with IPP grade 3 ( 1 10 mm) on transabdominal ultrasound and who were Alfuzosin naïve were shown to have almost 70% chance of failure of TWOC [17] . More recently, transrectal ultrasound was used to measure IPP in white males receiving Alfuzosin before TWOC and it was reported that men with IPP 1 10 mm were 6 times less likely to have a successful TWOC than those with IPP !…”

Section: Discussionmentioning

confidence: 72%

Alfuzosin 10 mg Once Daily Increases the Chances of Successful Trial without Catheter after Acute Urinary Retention Secondary to Benign Prostate Hyperplasia

Tiong¹,

Tibung²,

Macalalag³

et al. 2009

Urol Int

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Objective: To compare the efficacy of Alfuzosin XL 10 mg once daily for the acute management of acute urinary retention (AUR) with placebo in patients with benign prostatic hyperplasia (BPH) and to determine the predictors that impact this. Methods: 67 patients presenting with an initial episode of spontaneous AUR secondary to BPH were catheterized and were then prospectively randomized to receiving placebo or 10 mg Alfuzosin XL once daily for 2 days. The allocation and administration of treatment were double-blinded. The primary outcome measure was the rate of successful trial off catheter (TWOC) after 2 days. Clinical characteristics including intravesical prostatic protrusion (IPP) by transabdominal ultrasound were also assessed using uni- and multivariate analysis for their impact on successful TWOC. Results: Three patients withdrew from the study, 2 due to adverse effects of the trial medication. Analysis on an intention-to-treat basis showed a significantly greater proportion of patients in the Alfuzosin XL group (21 of 35 or 60%) had a successful TWOC compared with patients in the placebo group (11 of 32 or 34%) (p = 0.036). Patients with grade 3 IPP (>10 mm) had a significantly lower chance of successful TWOC (p = 0.04) compared to grade 1 (≤5 mm) and 2 (6–10 mm). It remained a significant independent predictor for failed TWOC after AUR (p = 0.034) on multivariate analysis. Conclusion: The administration of Alfuzosin XL prior to TWOC following AUR secondary to BPH increases the chance of successful catheter removal. Patients with IPP >10 mm are more likely to fail TWOC on Alfuzosin XL.

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“…Patients with Grade 3 IPP were less likely to void compared to those with Grade 1 IPP (67% vs. 36%). (13) Thirdly, IPP can predict the progression of BPH. Patients with Grade 3 IPP were more likely to have clinical deterioration compared to those with Grade 1 IPP (44% vs. 6%) at a mean follow-up period of 32 months.…”

Section: Pathophysiology Of Bphmentioning

confidence: 99%

Singapore Urological Association Clinical Guidelines for Male Lower Urinary Tract Symptoms/Benign Prostatic Hyperplasia

2017

smedj

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Intravesical Prostatic Protrusion Predicts the Outcome of a Trial Without Catheter Following Acute Urine Retention

Abstract: IPP is a useful predictor for evaluating the success of a voiding trial following ARU. Patients with a grade 1 prostate may benefit from a trial without a catheter. However, patients with a grade 3 prostate are less likely to do so and would require a more definitive surgical procedure.

Cited by 98 publications

References 6 publications

Management Outcome of Acute Urinary Retention

Management Outcome of Acute Urinary Retention

Alfuzosin 10 mg Once Daily Increases the Chances of Successful Trial without Catheter after Acute Urinary Retention Secondary to Benign Prostate Hyperplasia

Singapore Urological Association Clinical Guidelines for Male Lower Urinary Tract Symptoms/Benign Prostatic Hyperplasia

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