Predictors of Successful Trial without Catheter in Acute Urinary Retention

Abstract

We aim to identify predictors of successful trial without catheter after an episode of acute urinary retention and to evaluate how serum prostate specific antigen (PSA) and C-reactive protein (CRP) levels behave during an acute urinary retention episode and also whether the PSA level is a useful indicator of undetected prostate cancer. Patients and methods: 335 patients presented to our institution in acute urinary retention from June 2006 to December 2007. After excluding females, patients with known prostate cancer, clot retention due to haematuria and catheter-related problems, 100 patients were entered into this prospective audit. On admission we documented serum PSA and CRP levels, residual urine volumes, urinary tract infection (UTI), digital rectal examination (DRE) and history of urinary tract surgery. The outcome of subsequent trial without catheter (TWOC) was documented. Where indicated, repeat serum PSA and CRP levels, transrectal ultrasound and prostate biopsies were obtained. Parametric and non-parametric tests were used for statistical analysis. Results: Median residual volume on catheterization was 750 mL. Successful TWOC was more likely in smaller sized prostates (Kendall tau-b, p = 0.004) and in benign feeling prostates (Fisher Exact Test, p = 0.004). TWOC failure was significantly higher in patients diagnosed with new prostate cancer (Fisher Exact Test, p = 0.032). Higher initial PSA levels, higher residual volumes and larger prostate size on DRE also resulted in higher TWOC failure rates. However these correlations were not statistically significant. UTI was confirmed in 13 of 100 patients on admission. Presence of UTI on admission had no influence on CRP or PSA levels, residual volumes or outcome

Factors Affecting Trial Without Catheter for First Spontaneous Acute Urinary Retention

“…Lim et al [18] reported on 79 men with first spontaneous AUR, for which RV >800 mL correlated with failure, but no statistical significance was reported. A similar finding without statistical significance was reported by Zeif et al [9] for about 100 cases with median RV of 750 mL. Higher volumes (mean, 916 mL) resulted in lower success rates.…”

“…Multivariate regression analysis confirmed this (odds ratio, 1.92; 95% CI, 1.52 to 2.42; P<0.001). In a prospective audit of 100 patients who underwent TWOC without α-blockers, volume on USG was not considered [9]. Success was more likely in patients with smaller glands (P=0.004).…”

Predictors of successful trial without catheter following acute urinary retention in benign prostatic enlargement: A single centre, multivariate analysis

“…A French cross sectional study of 2 618 patients showed that 72.8% of patients had TWOC after a median of 3 days catheterization and if first TWOC failed, 33.4% had second TWOC before considering surgical intervention . There are various studies in English literature identifying the parameters which predicts the successful TWOC for AUR . The present study further contributes to the current knowledge by exploring the cut‐off values of the parameters that predicts successful TWOC with their sensitivity and specificity.…”

“…Hastie et al showed that patients less than 65 years had a more chances of positive outcome although it was not statistically significant. Mariappan et al found no association between TWOC outcome and age.…”

“…Identifying the patients who have high chances of failure of TWOC will allow early surgical intervention in them and reduce prolonged catheter related morbidity. There are various studies in English literature identifying the parameters, which predict the successful TWOC for AUR . In this study, besides predicting the parameters which influence the outcome of TWOC, a specific cut‐off value of each parameter is calculated which predicts successful TWOC along with its sensitivity and specificity in a large cohort of patients with AUR.…”