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

Abstract

Objectives: To 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 methods: In 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 α(1)-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.

Results: Of 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 α(1)-blocker (mainly alfuzosin) before catheter removal with consistently higher TWOC success rates, regardless of age and type of AUR. Multivariate regression analysis confirmed that α(1)-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.

Conclusions: TWOC has become a standard practice worldwide for men with BPH and AUR. In most cases, an α(1)-blocker is prescribed before TWOC and significantly increases the chance of success. Prolonged catheterization is associated with an increased morbidity.

FIG. 1

Triggering event in 1785 men catheterized for a precipitated acute urinary retention. UTI, urinary tract infection.

FIG. 2

Impact of α₁-blockade on trial without catheter (TWOC) success rate by age.

FIG. 3

Significant predictors of trial without catheter (TWOC) success in univariate analysis. P, precipitated acute urinary retention (AUR); S, spontaneous AUR; IPSS, International Prostate Symptom Score; catheter duration is expressed in days.

FIG. 4

Trial without catheter (TWOC) success rate by type of acute urinary retention (AUR) after one, two and three attempts.