Korean J Urol.  2012 Dec;53(12):843-847. 10.4111/kju.2012.53.12.843.

Analysis of the Treatment of Two Types of Acute Urinary Retention

• Park K
• Kim SH
• Ahn SG
• Lee SJ
• Ha US
• Koh JS
• Lee YS
• Han CH
• Cho SY
• Kim HW

• KMID: 1988729
• DOI: http://doi.org/10.4111/kju.2012.53.12.843

Abstract

PURPOSE
This study analyzed the type of acute urinary retention (AUR) and evaluated the treatments used, including trial without catheter (TWOC).
MATERIALS AND METHODS
This study was based on 299 patients who were treated for AUR from January 2007 to August 2009. The patients were classified into the spontaneous AUR group (group S) and the precipitated AUR group (group P), in which AUR was consecutive to triggering events. The treatment modalities including TWOC, the success rate of TWOC, age, prostate-specific antigen (PSA) levels, the volume of the prostate, and the drained volume at catheterization were analyzed in each group.
RESULTS
Of 299 men with AUR, 160 (54%) had spontaneous AUR and 139 (46%) had precipitated AUR. Compared with group P, patients in group S were more likely to be treated by surgery, either immediately (16.9% vs. 3.6%, p<0.05) or after prolonged catheterization (42.2% vs. 29.1%, p<0.05). The success rate of TWOC was lower in men of older ages (> or =70 years) and in those with enlarged prostates (> or =50 ml), higher PSA levels (> or =3 ng/ml), and a large drained volume at catheterization (> or =1,000 ml).
CONCLUSIONS
In this group of AUR patients, there were slightly more patients with spontaneous AUR (54%) than with precipitated AUR (46%). The success rate of TWOC was more than 70% regardless of the type of AUR. Although TWOC is recommended primarily in the treatment of AUR, early surgical intervention should be considered if the patient has an enlarged prostate (> or =50 ml) or a large drained volume at catheterization (> or =1,000 ml).

Keyword

Prostatic hyperplasia; Urinary catheterization; Urinary retention

MeSH Terms

Catheterization
Catheters
Humans
Male
Prostate
Prostate-Specific Antigen
Prostatic Hyperplasia
Urinary Catheterization
Urinary Retention
Prostate-Specific Antigen

Reference

1. Kurita Y, Masuda H, Terada H, Suzuki K, Fujita K. Transition zone index as a risk factor for acute urinary retention in benign prostatic hyperplasia. Urology. 1998. 51:595–600.

2. Jacobsen SJ, Jacobson DJ, Girman CJ, Roberts RO, Rhodes T, Guess HA, et al. Natural history of prostatism: risk factors for acute urinary retention. J Urol. 1997. 158:481–487.

3. Lepor H. The pathophysiology of lower urinary tract symptoms in the ageing male population. Br J Urol. 1998. 81:Suppl 1. 29–33.

4. Mebust WK, Holtgrewe HL, Cockett AT, Peters PC. Transurethral prostatectomy: immediate and postoperative complications. A cooperative study of 13 participating institutions evaluating 3,885 patients. J Urol. 1989. 141:243–247.

5. Murray K, Massey A, Feneley RC. Acute urinary retention: a urodynamic assessment. Br J Urol. 1984. 56:468–473.

6. Pickard R, Emberton M, Neal DE. National Prostatectomy Audit Steering Group. The management of men with acute urinary retention. Br J Urol. 1998. 81:712–720.

7. Emberton M, Fitzpatrick JM. The Reten-World survey of the management of acute urinary retention: preliminary results. BJU Int. 2008. 101:Suppl 3. 27–32.

8. Cravens DD, Zweig S. Urinary catheter management. Am Fam Physician. 2000. 61:369–376.

9. McNeill SA, Hargreave TB. Members of the Alfaur Study Group. Alfuzosin once daily facilitates return to voiding in patients in acute urinary retention. J Urol. 2004. 171(6 Pt 1):2316–2320.

10. Fitzpatrick JM, Desgrandchamps F, Adjali K, Gomez Guerra L, Hong SJ, El Khalid S, et al. Management of acute urinary retention: a worldwide survey of 6074 men with benign prostatic hyperplasia. BJU Int. 2012. 109:88–95.

11. Manikandan R, Srirangam SJ, O'Reilly PH, Collins GN. Management of acute urinary retention secondary to benign prostatic hyperplasia in the UK: a national survey. BJU Int. 2004. 93:84–88.

12. Taube M, Gajraj H. Trial without catheter following acute retention of urine. Br J Urol. 1989. 63:180–182.

13. Kumar V, Marr C, Bhuvangiri A, Irwin P. A prospective study of conservatively managed acute urinary retention: prostate size matters. BJU Int. 2000. 86:816–819.

14. Djavan B, Kazzazi A, Lepor H. BPH: Predicting TWOC failure in acute urinary retention. Nat Rev Urol. 2012. 9:181–182.

15. Hartung R. Do alpha-blockers prevent the occurrence of acute urinary retention? Eur Urol. 2001. 39:Suppl 6. 13–18.

16. McNeill AS, Rizvi S, Byrne DJ. Prostate size influences the outcome after presenting with acute urinary retention. BJU Int. 2004. 94:559–562.

17. Daly P, Connolly S, Rogers E, Sweeney P. Management outcome of acute urinary retention: model of prediction. Urol Int. 2009. 83:39–43.

18. Djavan B, Shariat S, Omar M, Roehrborn CG, Marberger M. Does prolonged catheter drainage improve the chance of recovering voluntary voiding after acute urinary retention (AUR) [abstract]. Eur Urol. 1998. 33:Suppl 1. 110. Abstract no. 437.

19. Alan McNeill S. The role of alpha-blockers in the management of acute urinary retention caused by benign prostatic obstruction. Eur Urol. 2004. 45:325–332.

20. Cockett , AT , Khoury S, Aso Y, Chatelain C, Denis L, Griffiths K, editors. Proceedings of the 3rd International Consultation on Benign Prostatic Hyperplasia (BPH). 1995. 1995 Jun 26-28; Monaco. Channel Island: Scientific Communications International Ltd;1–651.

21. McConnell JD, Roehrborn CG, Bautista OM, Andriole GL Jr, Dixon CM, Kusek JW, et al. The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med. 2003. 349:2387–2398.

22. Annemans L, Cleemput I, Lamotte M, McNeill A, Hargreave T. The economic impact of using alfuzosin 10 mg once daily in the management of acute urinary retention in the UK: a 6-month analysis. BJU Int. 2005. 96:566–571.

23. Shim JH, Sohng I, Jee KN, Kim HJ. Follow-up treatment of benign prostatic hyperplasia with acute urinary retention. Korean J Urol. 2006. 47:20–25.

24. Martorana G, Giberti C, Di Silverio F, von Heland M, Rigatti P, Colombo R, et al. Effects of short-term treatment with the alpha 1-blocker alfuzosin on urodynamic pressure/flow parameters in patients with benign prostatic hyperplasia. Eur Urol. 1997. 32:47–53.