Long-term outcome of patients with a successful trial without catheter, after treatment with an alpha-adrenergic receptor blocker for acute urinary retention caused by benign prostatic hyperplasia

Lo, Ka Lun; Chan, M. C. K.; Wong, Aline K.; Hou, See‐Ming; Ng, Chi‐Fai

doi:10.1007/s11255-009-9572-7

Cited by 21 publications

(12 citation statements)

References 25 publications

(27 reference statements)

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“…In our survey, enlarged prostates, severe LUTS, large drained volume and AUR of spontaneous origin were associated with an increased risk of TWOC failure. These variables have also been identified as predictors of recurrent AUR/surgery after a successful TWOC [9,18,20]. They could be used to select patients who should rapidly be offered a surgical procedure.…”

Section: Discussionmentioning

confidence: 99%

Management of acute urinary retention: a worldwide survey of 6074 men with benign prostatic hyperplasia

et al. 2011

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OBJECTIVESTo evaluate the management of acute urinary retention (AUR) associated with benign prostatic hyperplasia (BPH) in real-life practice.To identify predictors of successful trial without catheter (TWOC).MATERIALS AND METHODSIn all, 6074 men catheterized for painful AUR were enrolled in a prospective, cross-sectional survey conducted in public and private urology practices in France, Asia, Latin America, Algeria and the Middle East.Patient clinical characteristics, type of AUR and its management (type of catheterization, hospitalization, TWOC, use of α1-blockers, immediate or elective surgery) and adverse events observed during the catheterization period were recorded.Predictors of TWOC success were also analysed by multivariate regression analysis with stepwise procedure.RESULTSOf the 6074 men, 4289 (71%) had a spontaneous AUR and 1785 (29%) had a precipitated AUR, mainly as the result of loco-regional/general anaesthesia (28.5%) and excessive alcohol intake (18.2%).Presence of BPH was revealed by AUR in 44% of men. Hospitalization for AUR varied between countries, ranging from 1.7% in Algeria to 100% in France. A urethral catheter was inserted in most cases (89.8%) usually followed by a TWOC (78.0%) after a median of 5 days. Overall TWOC success rate was 61%.Most men (86%) received an α1-blocker (mainly alfuzosin) before catheter removal with consistently higher TWOC success rates, regardless of age and type of AUR. Multivariate regression analysis confirmed that α1-blocker before TWOC doubled the chances of success (odds ratio 1.92, 95% CI 1.52–2.42, P < 0.001).Age ≥70 years, prostate size ≥50 g, severe lower urinary tract symptoms, drained volume at catheterization ≥1000 mL and spontaneous AUR favoured TWOC failure. Catheterization >3 days did not influence TWOC success but was associated with increased morbidity and prolonged hospitalization for adverse events.In the case of TWOC failure, 49% of men were recatheterized and had BPH surgery and 43.5% tried another TWOC with a success rate of 29.5%. Elective surgery was preferred to immediate surgery.CONCLUSIONSTWOC has become a standard practice worldwide for men with BPH and AUR.In most cases, an α1-blocker is prescribed before TWOC and significantly increases the chance of success.Prolonged catheterization is associated with an increased morbidity.

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Section: Discussionmentioning

confidence: 99%

Management of acute urinary retention: a worldwide survey of 6074 men with benign prostatic hyperplasia

et al. 2011

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“…the use of anaesthetic or α‐sympathomimetic agents) and an α 1 ‐adrenoceptor antagonist at an attempt to remove the indwelling catheter 3 . A retrospective survey on 248 patients in whom indwelling catheters were successfully removed after treatment with an α 1 ‐adrenoceptor antagonist, with a mean follow‐up period of 33 months, reported a failure rate of 11.6, 14.3, 28.4, and 50.5% at 6, 12, 24 and 60 months, respectively 127 . Multivariate analysis revealed a prostatic volume ≥50 mL, and a PSA level ≥10 ng/mL at the time of acute urinary retention, as predictive factors for surgical intervention.…”

Section: Clinical Studymentioning

confidence: 99%

Outline of JUA clinical guidelines for benign prostatic hyperplasia

et al. 2011

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Abstract:The Japanese Urological Association has developed Clinical Guidelines for Benign Prostatic Hyperplasia (BPH) for men with suspected BPH, which have been abridged and translated into English. This article is a shortened version of the English translation. The Guidelines were formulated on the basis of evidence retrieved from the PubMed database between 1995 and 2009, as well as other relevant sources. The target patients of these Guidelines are men with suspected BPH, and the target users are urologists. A mandatory assessment should include a medical history, a physical examination, the completion of symptom and quality of life questionnaires, urinalysis, prostate ultrasonography, measurement of serum prostate specific antigen and postvoid residual urine, and an uroflowmetry. Optional tests include a bladder diary, the measurement of serum creatinine, and upper urinary tract ultrasonography. Care should be taken to not overlook coexisting diseases such as an infection or malignancy that may obscure the diagnosis. Treatment should consist of conservative therapy or the use of medications such as a 1-adrenoceptor antagonists, or both. The use of 5a-reductase inhibitors or anticholinergic agents should be considered in patients with an enlarged prostate (>30 mL) or overactive bladder symptoms (overactive bladder symptom score Ն6), respectively. Surgical intervention is indicated when nonsurgical treatments fail to provide sufficient symptomatic relief and bladder outlet obstruction is highly suspected.

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“…Serum PSA düzeyi 1.4 ng/ml'nin altında iken AÜR riskinin %0.5, 1.4 ng/ml'nin üzerinde iken %3.9 olduğu belirtilmiştir (19). Büyük prostat ve yüksek PSA düzeyi olan kişilerde tek başına alfa bloker ajanların yetersiz kaldığı gösterilmiştir (20). Alfa bloker ile tedavi başarısızlığı prostat volümü 40 ml üzerinde ise %72, 40 ml altında ise %48 bulunmuştur (21).…”

Section: Bph'nın Progresyonunu öNgörebilir Miyiz?unclassified

BPH’nın Progresyonunu Öngörebilir Miyiz?

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Long-term outcome of patients with a successful trial without catheter, after treatment with an alpha-adrenergic receptor blocker for acute urinary retention caused by benign prostatic hyperplasia

Cited by 21 publications

References 25 publications

Management of acute urinary retention: a worldwide survey of 6074 men with benign prostatic hyperplasia

Management of acute urinary retention: a worldwide survey of 6074 men with benign prostatic hyperplasia

Outline of JUA clinical guidelines for benign prostatic hyperplasia

BPH’nın Progresyonunu Öngörebilir Miyiz?

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