Trial without Catheter: What Predicts the Outcome in Acute Urinary Retention?. | [Pakistan Journal of Physiology • 2018]

Author(s):

1. Haroon Sabir Khan: Department of Urology, PNS Shifa, Karachi, Pakistan

2. Malik Nadeem Azam Khan: Department of Nephrology, PEMH, Karachi, Pakistan

3. Gulnaz Malik: CMH, Rawalpindi, Pakistan

Abstract:

Objective: To assess the outcome of conservative management by trial without catheter (TWOC) of patients subsequent to acute urinary retention due to bladder outlet obstruction caused by benign prostatic enlargement and to identify factors favouring positive result thereof. Methods: Cross sectional prospective case review study was conducted in Urology Department of PNS Shifa, Karachi, from August 2016 to March 2018. All patients presenting in emergency department with primary acute urinary retention caused by benign prostatic enlargement underwent trial without catheter, after initial catheterization to relieve retention. The variables recorded were: the duration and type of any previous lower urinary tract symptoms, prior retention episodes, associated anticholinergic medication, any precipitating cause of AUR, urine drained on catheterization and prostate size. Those who voided successfully after removal of catheter were followed up and their urinary flow rate measurement and ultrasonographic measurement of the post-void residual urine were recorded. Results: Of the 99 patients with AUR, 68 (68.6%) voided spontaneously after removing the catheter and continued to do so with mean peak flow rates of 10.3 mL/s and mean PVRs of 114 mL over a follow-up period of 5 to 13 months. These men had a mean prostate size of 39.2gm and a mean catheterized residual volume of 731 mL, while in those who had unsuccessful TWOC the mean prostate size was 63.7 gm (p=0.006) and a mean post catheterized residual volume of 1153 mL (p=0.08). Prostate size as assessed by the DRE was the most significant factor in predicting the outcome of trial without catheter. Conclusion: Trial without catheter is an acceptable protocol in the management of patients after an episode of acute urinary retention due to benign prostatic enlargement. The most significant factor for predicting the outcome of such a trial is size of prostate.

Page(s): 36-39

DOI: DOI not available

Published: Journal: Pakistan Journal of Physiology, Volume: 14, Issue: 4, Year: 2018

Keywords:

Conservative management , TWOC , trial without catheter , acute urinary retention

References:

[1] HastieKJ,DickinsonAJ,AhmadR,MoiseyCU, 1990.Acute retention of urine: is trial without catheter justified?,J R Coll Surg Edinb 35 225 -7

[2] PickardR,EmbertonM,NealDE, 1998.The management of men with acute urinary retention,National Prostatectomy Audit Steering Group. Br J Urology 81 712 -20

[3] Sajjad A. A, 2004.Comparative Study of BPH - Patients undergoing TURP as elective surgery versus those in Acute Urinary Retention,J Postgrad Med Inst 18 305 -7

[4] EmbertonM,FitzpatrickJM, 2008.The Reten-World survey of the management of acute urinary retention: preliminary results,BJU Int 101 27 -32

[5] BlandyJP,BlandyJP, 1976.Benign enlargement of the prostate gland,Urology 859 -913

[6] ZeifHJ,SubramonianK., 2009.(4):CD006744.,Cochrane Database Syst Rev -

[7] YoonPD,ChalasaniV,WooHH, 2015.Systematic review and metaanalysis on management of acute urinary retention,Prostate Cancer Prostatic Dis 18 297 -302

[8] NazirMI,AminY,AbbasF,AtherH, 2014.Determination of the effect of Alfuzosin in patients with acute urinary retention secondary to benign prostatic enlargement,Biomedica 30 276 -9

[9] QaziSM,GulW., 2016.Trial without catheter with alpha blockers in acute urinary retention due to benign prostatic hyperplasia,Ann Pak Inst Med Sci 12 166 -70

[10] 1998.Does prolonged catheter drainage improve the chances of recovering voluntary voiding after acute urinary retention,Eur Urol 33 110 -

[11] DesgrandchampsF,De La TailleA,DoubletJD, .The management of acute urinary retention in France: a crosssectional survey in 2618 men with benign prostatic hyperplasia, -

[12] 2006.,BJU Int 97 727 -33

[13] TaubeM,Gajraj H, 1989.Trial without catheter following acute retention of urine,Br J Urol 63 180 -2

[14] PanditRK,AgrawalCS,ChalisePR,SapkotaG, 2008.Retrospective analysis of management of patients presenting with acute urinary retention due to benign prostatic hyperplasia: A hospital based study,Kathmandu Univ Med J 6 448 -52

[15] LeeKS1,LimKH,KimSJ,ChoiHJ,NohDH,LeeHW, ., -

[16] 2011.Predictors of successful trial without catheter for postoperative urinary retention following non-urological surgery,Int Neurourol J 15 158 -65

[17] 2013.Factors affecting trial without catheter for first spontaneous acute urinary retention,Int Neurourol J 17 121 -6

[18] BansalA,AroraA, 2017.Predictors of successful trial without catheter following acute urinary retention in benign prostatic enlargement: A single centre, multivariate analysis,Neurourol Urodyn 36 1757 -62

[19] KumarV,MarkC,BhuvangiriA,IrwinP., 2000.A prospective study of conservatively managed acute urinary retention: Prostate size matters,BJU Int 86 816 -9

[20] McNeillAS,RizviS,ByrneDJ, 2004.Prostate size influences the outcome after presenting with acute urinary retention,BJU Int 94 559 -62

Citations

Downloads

Views