Management of acute urinary retention secondary to benign prostatic hyperplasia in the UK: a national survey

Abstract

RESULTSWe received 270 (66%) replies, of which six were excluded because they were from subspeciality interests (e.g. paediatric urology) or had ambiguous answers; 264 (64%) were therefore available for analysis. Urethral catheterization was the initial management of choice (98%), failing which a suprapubic catheter was inserted. Two-thirds (65.5%) admitted the patient after catheterization. Most consultants initiated a -blockers (70.5%), with 64% (118) of these using a TWOC 2 days after starting them. One failed TWOC was an indication for transurethral resection of the prostate for 192 (72.8%), with 136 (49.8%) re-admitting the patient for surgery later. Routine follow-up after a successful TWOC was advocated by 77.3%. Just over half the respondents (52.6%) felt that there was no need for uniform guidelines in the management of AUR secondary to BPH. CONCLUSIONThis survey identified a reasonable national uniformity in managing AUR secondary to BPH in the UK, but significant aspects of current practice are not evidence-based. KEYWORDSacute urinary retention, management, a -blocker, trial without catheter, BPH, surgery OBJECTIVETo analyse current practice in the management of acute urinary retention (AUR) secondary to benign prostatic hyperplasia (BPH) in the UK, and to assess how much of this is evidence-based. METHODSIn all, 410 consultant urologists practising in UK hospitals were sent a questionnaire about the management of AUR secondary to BPH. Data were collected on practice relating to initial management, trial without catheter (TWOC), the use of a -blockers and the followup. The need for a uniform guideline in the management of AUR secondary to BPH was also assessed. INTRODUCTIONAcute urinary retention (AUR) remains the most common urological emergency and is usually caused by BPH [1]. We sought to assess the current practice in the management of AUR secondary to BPH in the UK, and to what degree this was evidence-based. METHODSWithin the UK, 410 consultant urologists were sent a questionnaire about the management of AUR specifically secondary to BPH. We received 270 (65.9%) responses, of which six were excluded from the analysis because of their speciality interests (paediatric urology) or ambiguity in the answers. The remaining 264 were evaluated. RESULTSMost urologists preferred urethral catheterization as the initial management, failing which a suprapubic catheter was inserted (98%). Apart from routine blood investigations, ultrasonography (26.5%), a plain film of the abdomen (15.5%) and PSA assay (24.6%) were part of the routine assessment by some. Nearly 71% (186) started their patients on a -blockers, with 64% (118) using a trial without catheter (TWOC) 2 days after starting them; 39% (103) used a TWOC only if the residual urine volume was <1 L at the time of initial catheterization, and 77% followed patients who had had a successful TWOC. One failed TWOC was an indication for TURP for 72.8% (192) of the respondents, with 49.8% (136/233) undertaking TURP at a separate admission. A second TWOC was ad...

1098 Efficacy and safety of silodosin and dutasteride combination therapy in acute urinary retention due to benign prostatic hyperplasia: A single-arm prospective study

“…In addition, Murray et al reported that up to 23% patients with AUR did not require prostatectomy based on urodynamic assessment [13]. In contrast, TWOC involves removing the catheter after 1-3 days, which allows 23%-40% of patients to void successfully [5,6].…”

“…Although a trial without catheter (TWOC) is the standard of care for AUR [5], TWOC typically involves removing the catheter after 3 days, which allows only 23%-40% of patients to void successfully [5,6]. TWOC in which catheter removal followed 2-3 days of -blocker (AB) improves success rates [7].…”

Рrevention and treatment of acute urinary retention in patients with benign prostatic hyperplasia

“…Основным лечебным мероприяти-ем, применяющимся для разрешения ОЗМ, является катетеризация мочевого пузыря (МП) -быстрый и эффективный способ эвакуации мочи. Согласно дан-ным, опубликованным в BJU, так поступают 98 % из опрошенных урологов Великобритании [9], причем длительность дренирования прямо пропорциональна вероятности восстановления самостоятельного моче-испускания и увеличивается в 1,4 раза при пролонгации этого периода с 1-х до 7-х суток [7]. Следует отметить, что обратной стороной длительной катетеризации яв-ляется риск присоединения уретральной инфекции и развития уретрита [10].…”

“…Так, 70,5 % из опрошен-ных урологов начинают терапию -адреноблокаторами непосредственно в день установки уретрального кате-тера [9].…”

Hydronephrosis Predicts Successful Catheter Removal after Painful Urinary Retention - Preliminary Results of a Prospective Single Center Study

“…Therefore, it seems to be important to characterize those patients who can be managed conservatively after AUR. Several studies propose a conservative approach with or without a period of α-blocking therapies [7,8,9]. …”