Introduction and Objectives
Acute urinary retention (AUR), remain an important health issue. AUR is complex and may present in various ways as results of a myriad of pathologic processes. Once AUR occurs,delay of surgery when possible must be the aim to reduce the risk of perioperative morbidity and mortality as well as to allow the bladder to recover its contractility. Treatment of AUR requires urgent catheterisation.Trial without catheter (TWOC) after indwelling Foley catheter for several days is widely accepted and recommended for the initial management of AUR. However, this management causes both physical and psychological stress and also increases urinary tract infections (UTI) rate. This study aimed to asses the effects of single intermittent catheterisation (SIC)as a modality of TWOC in patients (pts) with AUR due to benign prostatic hyperplasia(BPH) and also to access the determinant factors affecting success of TWOC.
Material and Methods
A total of 72 pts with first episode of spontaneous AUR due to BPH, where enrolled and analyzed in this randomized double-blind trial and were follow-up, at least 12 month. The subject were initially managed with SIC and received alpha adrenoceptor blocker (ARB)Omnic Ocas, during follow-up. The pts who had previous retention history, neurogenic bladder, urethral stricture, prostate cancer, pelvic operation and UTI sign were excluded. The success of TWOC was defined that the pts regained self voiding and free for AUR,at least one year. The possible parameters such as age,retension volume, prostate size, IPSS/QoL, PSA, serum kreatinine, diabetes mellitus and alcohol intake were analyzed and compared between success and failure group. Curve was drawn to assess adequate retention volume for TWOC with SIC.
The success rate of TWOC with SIC was 48.6% (35pts).The amount of adequate retention volume of success group was significantly less than failure group. The multivariate analyses revealed that the only significant determinant factor related to success was urine retention volume (p < 0.01). The maximal cut-off value of retention volume that preserved 100% of sensitivity was 500mL. With cut-off value of 750 mL,the success TOWC had a sensitivity of 76% and about 1000 mL had 18.3%, respectively.
AUR remains a significant burden for both the pts and health care service. AUR due to BPH may be associated with an increase in alpha-adrenergic activity and ARB may decrease bladder outlet resistance, thereby facilitating normal micturition. SIC may be consider as a modality of TWOC for the pts with first episode of spontaneous AUR due to BPH, especially for the pts with relatively small amount of retention volume. In the second part of the study, pts with initially successful TWOC were more likely to have recurrent AUR if their post-TWOC volume was high. Finally, perhaps it is the time to use SIC and ARB as a first-line approach.
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.