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

OBJECTIVE: To 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. METHODS: In 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 alpha-blockers and the follow-up. The need for a uniform guideline in the management of AUR secondary to BPH was also assessed. RESULTS: We 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 alpha-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. CONCLUSION: This 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.     

Prostate size influences the outcome after presenting with acute urinary retention

OBJECTIVE: To evaluate the long-term outcome in an open follow-up of a cohort of patients who had had a successful trial without catheter (TWOC) after an episode of acute urinary retention (AUR), as it is now widely accepted that giving an alpha-blocker, e.g. alfuzosin, increases the success rate of TWOC. PATIENTS AND METHODS: In this prospective trial, 81 patients with a first episode of AUR related to benign prostatic obstruction received either sustained-release alfuzosin (40) 5 mg twice daily or placebo (41) for 48 h. The catheter was removed after 24 h of treatment and the patient's ability to void assessed. Those who voided successfully entered an open follow-up, the defined endpoints of which were the date of recurrent AUR, date of bladder outlet surgery, date of last follow-up or death, and factors that influenced the long-term outcome after a successful TWOC were examined. RESULTS: Of the 34 patients who had a successful TWOC (22 on alfuzosin, 12 placebo, P= 0.03), 21 continued on an alpha-blocker at the discretion of their urologist. In all, 26 had a further episode of AUR or surgery during the 6-year follow-up. The mean (median, range) time to the second episode of AUR in the 20 (59%) patients affected was 1.4 (0.6, 0-5.95) years. Nineteen (56%) men had bladder outlet surgery, 13 after a second episode of AUR. The mean time to operation after the first AUR was 1.85 (1.1, 0.04-5.4) years. The remaining eight (24%) patients remained free of further AUR and surgery. The size of the prostate assessed on a digital rectal examination by the admitting urologist was the only factor with a significant effect on the long-term outcome. A postvoid residual of > 50 mL was associated with a greater likelihood of recurrent AUR or surgery, but this was not statistically significant. CONCLUSIONS: This study provides further evidence of the importance of prostate size as a prognostic factor in determining the outcome in patients with prostatic obstruction. Whilst most men presenting with AUR will eventually have prostatic surgery, a significant minority will not. An assessment of risk factors such as prostate size may identify those who require urgent intervention after a successful TWOC. The role of continued medical therapy with alpha-blockers and/or 5alpha-reductase inhibitors after a successful TWOC merits further investigation.     

Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia: Prevention or Retention?

BackgroundAcute urinary retention (AUR) is a severe complication of lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH). The prevention and management of AUR is subject to debate and varies considerably among countries.ObjectiveTo review the current and future prevention and management of AUR secondary to LUTS/BPH.Evidence acquisitionThis paper summarises the content of an update lecture that was part of a symposium on the management of LUTS/BPH held at the annual meeting of the European Association of Urology (EAU) in 2008. During the symposium, the results of a Web-based survey evaluating urologists’ opinions on the management of LUTS/BPH were also presented and discussed.Evidence synthesisPrevention of AUR secondary to LUTS/BPH implies delaying the progression of this condition in patients at risk. Risk factors for AUR include the following: an advanced age, moderate-to-severe lower urinary tract symptoms (LUTS), an enlarged prostate, a low peak urinary flow rate, an elevated postvoid residual, and an elevated prostate-specific antigen (PSA) level. Chronic inflammation of the prostate might also be a predictor of AUR. First-line treatment of AUR usually involves decompression of the bladder by catheterisation, which can be followed by a trial without catheter (TWOC) or immediate surgery. Elective surgery after TWOC is preferred to immediate surgery because it is associated with a lower morbidity and mortality risk. Treatment with an α₁-adrenoceptor (α₁-AR) antagonist can increase the success rate of a TWOC.ConclusionsPrevention and management of AUR secondary to LUTS/BPH should be based on the presence of risk factors. In most cases, elective surgery after TWOC is preferred to immediate surgery. Treatment with α₁-AR antagonists is usually indicated when performing a TWOC.     

前列腺增生急性尿潴留TWOC失败的因素分析

目的分析前列腺增生引起的急性尿潴留患者进行留置导尿后再予以试行拔除尿管(TWOC)后患者再次发生尿潴留的危险因素。方法回顾性分析2017年4月至2019年4月在自贡市第一人民医院治疗的前列腺增生并发第一次急性尿潴留的65例患者的临床资料,65例患者既往均接受了在留置尿管后口服0.4mg/d盐酸坦索罗辛并在第3天进行试行拔管的处理,拔管后患者再次出现尿潴留视为TWOC失败,单因素及多因素Logistic回归分析患者年龄、前列腺体积、膀胱内前列腺突出度(IPP)、国际前列腺症状评分(IPSS)等相关参数与TWOC失败的相关性。结果 TWOC成功组23例(35.4%),TWOC失败组42例(64.6%),单因素分析结果显示TWOC成功组与失败组比较前列腺体积(P=0.030)、IPSS(P<0.001)、IPP(P=0.002)存在明显统计学差异。多因素Logistic回归分析得出患者IPSS(OR=2.462,95%CI:1.216~4.985,P=0.012),IPP(OR=2.606,95%CI:1.224~5.545,P=0.013)是TWOC失败的独立危险因素。结论患者IPP、IPSS评分是预测TWOC失败的重要指标。     

The management of acute urinary retention in France: a cross-sectional survey in 2618 men with benign prostatic hyperplasia

In an important study from France, the authors assessed the management of acute urinary retention in a cross‐sectional survey of many patients in their country. They describe what has become standard practice for men with BPH who present in this manner. They also suggest that efforts should be made to reduce the duration of catheterization, to reduce morbidity. In an international study, a group of authors found that alfuzosin prevents BPH progression but not acute urinary retention. This was a 2‐year study, and the authors also found that the drug improved LUTS and quality of life.

OBJECTIVE

To evaluate current practice in the management of acute urinary retention (AUR) in men with benign prostatic hyperplasia (BPH) in France.

PATIENTS AND METHODS

In all, 2618 men (median age 72 years) presenting with non‐febrile AUR were enrolled by 658 French urologists in a prospective cross‐sectional survey. The patients’ demography, history of BPH, type of AUR and its management (trial without catheter, TWOC, use of α₁‐blockers, immediate or elective surgery, other alternatives) were collected.

RESULTS

Of the 2618 men analysed, 1875 (71.6%) had spontaneous AUR (sAUR) and 743 (28.4%) had precipitated AUR (pAUR), mainly after surgery with locoregional or general anaesthesia. BPH was revealed by AUR in 52.3% of men with pAUR and 25.9% of men with sAUR. A urethral catheter was inserted in most cases (82.7%) while only 16.7% had a suprapubic catheter. After initial catheterization, 72.8% of men had a TWOC (pAUR 89.4%, sAUR 66.2%, P < 0.001) after a median of 3 days of catheterization, 17.9% had elective surgery after a median of 8 days of catheterization (pAUR 7.1%, sAUR 22.1%, P < 0.001), 5.7% had immediate surgery after a median of 4 days of catheterization (pAUR 1.1%, sAUR 7.5%, P < 0.001), 0.4% had a urethral stent inserted and 1.1% had an indwelling catheter. Of the 1906 men who had a TWOC, 79% received an α₁‐blocker (mainly alfuzosin) before catheter removal. The TWOC was successful in 50.2% of men (pAUR 52.3%, sAUR, 49.0%, P = 0.17) and the success rate was significantly higher in men receiving an α₁‐blocker (53.0% vs 39.6%, P < 0.001) before the TWOC. If the TWOC failed, 33.4% had a second TWOC (pAUR 39.9%, sAUR 30.2%, P = 0.003) after a median of 7 days re‐catheterization, 57.5% had elective surgery (pAUR 49.1%, sAUR, 61.7%, P < 0.001) after a median of 8 days re‐catheterization, 1.5% had a stent inserted and 1.1% had an indwelling catheter. The overall success rate of a second TWOC was 25.9% (pAUR 32.2%, sAUR 21.9%, P = 0.04). Men catheterized for >3 days had a slightly lower success rate for TWOC, greater comorbidity and double the rate of prolonged hospitalization due to adverse events than those catheterized for ≤ 3 days.

CONCLUSIONS

TWOC after a median of 3 days of catheterization has become standard practice in France for men with BPH and AUR. α₁‐blockade before a TWOC significantly increases the chance of a successful TWOC. If the TWOC fails, only a quarter of men will have a successful second TWOC. All efforts should be made to reduce the duration of catheterization, to reduce the comorbidity.

     

The economic impact of using alfuzosin 10 mg once daily in the management of acute urinary retention in the UK: a 6-month analysis

OBJECTIVE: To calculate the economic consequences of using alfuzosin 10 mg once daily for managing acute urinary retention (AUR) related to benign prostatic hyperplasia (BPH). METHODS: We examined whether alfuzosin use during hospitalization for AUR and for 6 months after a successful trial without catheter (TWOC) is cost effective compared to placebo and immediate prostatectomy, from the perspective of patients managed in the National Health Service (NHS) in the UK. A decision-analysis model was developed to estimate the costs of various treatment options within the first 6 months after a first episode of AUR. Clinical data were obtained from a large randomized clinical trial comparing alfuzosin 10 mg with placebo, and from published reports. Cost data were obtained from both NHS and resource-use data gathered during the clinical trial. A Monte Carlo analysis, allowing variability in all uncertain variables of the model, was used to calculate the uncertainty surrounding the results. RESULTS: Treating patients with alfuzosin during initial hospitalization for AUR and in the first 6 months after a successful TWOC generates a cost-saving of pounds 349 relative to placebo. Savings related to immediate prostatectomy were pounds 892; both savings were significant (P < 0.05). Alfuzosin treatment was associated with a lower rate of prostatectomy after discharge from hospital after a successful TWOC. CONCLUSION: Treatment with alfuzosin 10 mg once daily before and after a successful TWOC has both clinical and economic benefits. It decreases the need for emergency surgery for BPH and reduces treatment costs in the first 6 months.     

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

Study Type – Therapy (symptom prevalence) Level of Evidence 2a What's known on the subject? and What does the study add? Largest survey ever conducted evaluating the management of AUR in real life practice in a wide range of health care systems. It shows that urethral catheterization followed by a TWOC has become a standard worldwide and that α₁‐blockade prior to TWOC doubles the chances of success. It also evidences important differences (hospitalization rate, duration of catheterization ...) between countries/regions reflecting lack of guidelines. This large survey also clearly identifies predictors of TWOC failure.

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 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.

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 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.

CONCLUSIONS

• ? TWOC 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.

     

Randomised,placebo controlled,double blind study of alfuzosin SR in patients undergoing trial without catheter following acute urinary retention

INTRODUCTION: Acute urinary retention caused by bladder outlet obstruction resulting from prostatic enlargement is one of the commonest causes for acute admission to urology wards. More recently, there has been a trend to commence treatment with alpha-blockers after catheterisation followed by a trial without catheter (TWOC), in the hope that surgery may be avoided in a significant proportion of patients. There is no conclusive evidence of the efficacy of this treatment. We conducted a study to evaluate the efficacy of using the alpha-blocker alfuzosin SR in patients with acute urinary retention. PATIENTS AND METHODS: All patients presenting with acute urinary retention to our unit were included in the trial. Exclusion criteria included patients with known bladder or prostate malignancy, bladder calculi, urinary tract infections, urethral stricture or patients on alpha-blockers. A total of 81 patients consented and were randomised. Sixty-two patients completed the study. The retention volume was recorded. Trial medicine was recorded on a twice-daily dose and the first TWOC was carried out after a minimum of three doses or 36 hours after admission. TWOC was considered successful on voiding with a residual volume of <200 ml. Unsuccessful patients were recatheterised and discharged home on trial medication, and called for a second TWOC after 2 weeks. Successful patients were continued on alpha-blockers and failures were put on the operating list for TURP. Patients on active treatments were reviewed at 2 year. RESULTS: Of the 34 patients treated with alfuzosin SR, 17 (50%) resumed voiding and of the 28 patients from placebo group, 16 (57%) voided successfully. All 33 patients were continued open labelled on alfuzosin SR 5mg BD. Out of 33 patients, 13 (43%) had TURP within first year after TWOC and three died due to various medical causes. Out of remaining 17 patients, 15 attended for follow-up. The mean peak flow rate was 8.4 ml/s and the mean residual volume was 112 ml. Six patients (40%) required TURP for severe lower urinary tract symptoms (LUTS). So out of 28 patients followed at 2 year, 19 (68%) had TURP. CONCLUSIONS: These data do not support the routine use of alpha-blockers in patients with acute urinary retention. Also continuing use of alpha-blockers does not seem to prevent further requirements of TURP, although larger studies are needed to support this.     

A comparative study on the use of tamsulosin versus alfuzosin in spontaneous micturition recovery after transurethral catheter removal in patients with benign prostatic growth

Purpose

To compare the efficacy and safety of tamsulosin and alfuzosin in patients with acute urinary retention (AUR) secondary to benign prostatic hyperplasia (BPH).

Methods

Ninety men with AUR due to BPH underwent urinary catheterization and were randomly assigned to treatment groups with tamsulosin 0.4 mg (37 patients), alfuzosin 10 mg (34 patients), and placebo (19 patients). After 4 days of the drug treatment, the catheters were removed, and the patients underwent trial without catheter (TWOC). A TWOC was considered successful if the patient had a voided volume >100 ml and post-void residual urine <200 ml.

Results

TWOC was successful in 16 patients (43.2 %) in the tamsulosin group, 12 patients (35.2 %) in the alfuzosin group, and 5 patients (26.3 %) in the placebo group. Logistic regression analysis showed that both drugs were equally effective and that the type of alpha-blocker was not a predictive factor for TWOC success (OR 1.137, 95 % CI 0.639–2.022) (p = 0.662).

Conclusion

Even though there were no statistically significant differences when comparing the three groups, tamsulosin showed a tendency to be more effective in a successful catheter removal. The lack of objective criteria in the definition of successful micturition leads us to believe that the effectiveness of both drugs reported in the literature is overestimated.     

The Reten-World survey of the management of acute urinary retention: preliminary results

Acute urinary retention (AUR) is a urological emergency characterized by a sudden and painful inability to pass urine. It represents a significant worldwide public health issue, as mortality within the year following an AUR episode appears much higher than in the general population, especially in younger patients. Management of AUR involves immediate bladder catheterization usually followed, until recently, by prostatic surgery. The greater morbidity and mortality associated with emergency surgery (within a few days after AUR), and the potential morbidity associated with prolonged catheterization (bacteriuria, fever, urosepsis) has led to an increasing use of a trial without catheter (TWOC). TWOC involves catheter removal after 1-3 days, allowing 23-40% of patients to void successfully, so that surgery can be performed at a later stage, if needed. Use of an alpha(1)-blocker before a TWOC may also be of help, as it has been demonstrated that it increases the chances of successful voiding after catheter removal. In the UK, this TWOC policy has resulted in a progressive decrease in the number of surgical procedures following a first episode of AUR, with the detriment of a slight increase in the AUR recurrence rate. Currently, there is no consensus on the optimal management of AUR in terms of type of catheterization, duration of catheterization and management following catheterization. The Reten-World survey is aimed at assessing current practice in the management of AUR in France, Asia, Latin America, North Africa and the Middle East. Interim results based on 3785 men with AUR associated with benign prostatic hyperplasia show that a urethral catheter is inserted in most cases (87%). Following this initial step, a TWOC after a median of 3 days' catheterization has become standard practice worldwide, with only a minority of men (6%) undergoing immediate surgery. Treatment with an alpha(1)-blocker before a TWOC improves the chances of success, regardless of the duration of catheterization. There is also evidence that prolonged catheterization (>3 days) is associated with a significantly higher rate of comorbidity and prolonged hospitalization due to adverse events. Every effort should thus be made to reduce the comorbidity and mortality associated with AUR.     

A prospective study of conservatively managed acute urinary retention: prostate size matters

OBJECTIVE: To evaluate in a prospective study the medium- to long-term outcome of a policy of conservatively managing acute urinary retention (AUR), arising solely by bladder outlet obstruction caused by benign prostatic enlargement (BPE), and to identify the factors favouring a positive outcome of a trial without catheter (TWOC). PATIENTS AND METHODS: All men admitted as an emergency with primary AUR caused by BPE (from August 1997 to March 2000) underwent a TWOC. The following variables were recorded; the nature and duration of any preceding lower urinary tract symptoms, previous episodes of retention, concomitant anticholinergic medication, coexisting constipation, alcohol as a precipitating cause of AUR, previous prostatectomy, confirmed urinary tract infection, residual urine drained on catheterization and prostate size, as determined by a digital rectal examination (DRE) carried out by one consultant urologist in all patients. Those voiding successfully were followed up prospectively using the International Prostate Symptom Score (IPSS), quality-of-life score, urinary flow rate measurement and ultrasonographic measurement of the postvoid residual (PVR). RESULTS: Of the 40 men with AUR, 22 (55%) voided spontaneously after removing the catheter and continued to do so with mean peak flow rates of 12.2 mL/s and mean PVRs of 69.6 mL over a follow-up of 8-24 months. These patients remained asymptomatic, with a mean IPSS of 5.2 and quality-of-life score of 0.9. These men had a mean prostatic size of 15.9 g and a mean catheterized residual volume of 814 mL, while in those who had an unsuccessful TWOC the mean prostate size was 27.5 g (P = 0.006) and a mean catheterized residual volume of 1062 mL (P = 0.09). Prostate size as assessed by the DRE was the most significant factor in predicting the outcome of a TWOC. CONCLUSION: A TWOC is justified in the long-term for men presenting with AUR caused by BPE. Prostate size is the most important factor for predicting the outcome of such a trial.     

Reporting of acute urinary retention in BPH treatment trials: importance of patient follow-up after discontinuation and case definitions

Objectives. A growing number of reports of retrospective analyses of adverse events occurring during studies with alpha-blockers in men with benign prostatic hyperplasia (BPH) have compared acute urinary retention (AUR) event rates with placebo-controlled finasteride trials. Because of differences in study designs, the present analysis was undertaken to compare data on the rates of AUR across different BPH trials accurately.Methods. We report the incidence of spontaneous AUR for placebo, finasteride, and alpha-blockers based on published data in randomized clinical trials in men with BPH.Results. On the basis of the data from all published randomized finasteride and alpha-blocker studies reporting AUR, the overall incidence rate for spontaneous AUR during active treatment with placebo, alpha-blockers, and finasteride ranged from 0.9 to 5.2, 0 to 1.2, and 0.3 to 1.2, respectively. The only study to provide data on AUR occurring during post-treatment follow-up was the Proscar Long-Term Efficacy and Safety Study (PLESS), in which approximately 25% of events occurred in patients after they had discontinued the study. Several of the alpha-blocker studies had significantly shorter durations, relatively small patient populations with smaller prostate volumes, lower numbers of events reported, and higher discontinuation rates with no follow-up, all of which could tremendously affect the reporting of AUR. Additionally, only PLESS reported on both spontaneous and precipitated AUR.Conclusions. Simply comparing the reported rates of AUR from published studies without taking into consideration spontaneous versus precipitated AUR, discontinuation rates, total patient follow-up, and prostate volume does not adequately allow for comparison of the true event rate across different clinical trials.     

Predictors of outcome in patients with benign prostatic hyperplasia maintained on alpha-blockers

Aim: To determine factors that could predict failure of medical treatment or the need for surgical intervention in patients with benign prostatic hyperplasia (BPH) who were maintained on alpha-blockers. Methods: 124 eligible patients aged 51–82 years (mean 66.8) with lower urinary tract symptoms attributable to BPH treated with alpha-blockers were included in the study. Initial assessments included a complete medical history, physical examination, blood biochemistry, serum prostate-specific antigen and urinalysis. Baseline symptoms were assessed by International Prostate Symptoms Score (IPSS) questionnaire, peak urine flow rate (Qmax) and post-void residual urine volume (PVR). Transrectal ultrasound (TRUS), prostate biopsy, cystoscopy and urodynamic study were carried out when indicated. Mean follow-up was 47.7 months. Baseline parameters were compared between the cohort of patients requiring surgical intervention and the remaining cohort who were still maintained on alpha-blockers. Results: Forty-four patients (35.5%) demanded surgical intervention despite treatment with alpha-blockers. Patients requiring surgical intervention had significantly worse baseline IPSS, quality-of-life score, Qmax and PVR when compared with those not requiring surgery. Risk analysis using binary logistic regression model showed that IPSS (odds ratio: 1.096; P = 0.001) and PVR (odds ratio: 1.006; P = 0.008) were independent predictors for surgical intervention. Receiver–operating characteristics curves further demonstrated that IPSS was slightly better than PVR as a single predictor. Kaplan–Meier cumulative risk analyses showed that patients with baseline IPSS ≥ 14 or PVR ≥ 100 mL were more likely to require subsequent surgical intervention than their counterparts. Conclusions: In patients with BPH who were maintained on alpha-blockers, baseline IPSS and PVR were two useful independent predictors for failure of medical treatment and the need for surgical intervention.     

Spontaneous versus precipitated AUR: the same?

The differentiation between spontaneous and precipitated acute urinary retention was initially made by the PLESS study group. Acute urinary retention (AUR) occurring in the PLESS study, whether considered spontaneous or precipitated, was BPH-related as it occurred in a carefully selected population. It is known that AUR can be precipitated in patients without BPH by events such as anaesthesia and CVA. Therefore when assessing how to manage a patient with AUR, one should first consider whether or not the event is BPH-related. If BPH is thought to be present, then the management is likely to involve a trial without catheter following administration of an alpha-blocker. The presence of a factor that is considered to have precipitated or provoked the episode of AUR may influence the outcome in the longer term but there is little evidence that it alters the likelihood of a successful trial of voiding. Consequently spontaneous and precipitated AUR may be considered to be the same when they are BPH-related, as the approach to management need not be altered. Such differentiation is only likely to influence immediate management when AUR is truly precipitated in the absence of BPH.     

α-Blockers in the management of acute urinary retention: Results of a double-blind,placebo-controlled study

Conclusions Alfuzosin 10 mg once daily increased the likelihood of successful TWOC in men with a first episode of spontaneous AUR and should be continued beyond the acute phase, as it reduced the need for BPH surgery during a 6-month treatment period.     

Finasteride significantly reduces acute urinary retention and need for surgery in patients with symptomatic benign prostatic hyperplasia

Objectives. A pooled analysis of all available randomized trials with 2-year follow-up data with finasteride and placebo was undertaken to further investigate recent observations that finasteride use may reduce the occurrence of acute urinary retention (AUR) and benign prostatic hyperplasia (BPH)-related surgical intervention.Methods. Occurrences of AUR and surgical intervention were examined by treatment group in a pooled series of 4222 men with moderately symptomatic BPH.Results. In total, 81 occurrences of AUR were reported, 24 (1.1%) of 2113 in the finasteride group and 57 (2.7%) of 2109 in the placebo group. The hazard ratio was consistent in all three studies, with a 57% decrease in the hazard rate for occurrence of AUR with finasteride compared with that for placebo present in the pooled data set over the 2-year study period (P <0.001). Additionally, 227 surgical interventions were recorded over the 2-year study period, 89 (4.2%) of 2113 in the finasteride group and 138 (6.5%) of 2109 in the placebo group. The hazard ratio was consistent across the three studies, with a 34% reduction in the hazard rate for occurrence of surgery with finasteride compared with that for placebo (P <0.002). Overall, there was 35% reduction in the two BPH-related end points (ie, AUR or surgery).Conclusions. Treatment with finasteride for up to 2 years more than halves the frequency of AUR and reduces surgical intervention by over one third relative to placebo in patients with moderate BPH. This is the first demonstration that long-term medical therapy can reduce clinically significant end points such as AUR or surgery, and these data have important implications for the long-term management of patients with BPH.     

Ambulatory care program for patients presenting with acute urinary retention secondary to benign prostatic hyperplasia

Objective

We analyze the clinical and economical outcomes of an ambulatory care program for the management of patients presenting to the emergency department with acute urinary retention (AUR).

Method

A standardized ambulatory care program for managing male patients presenting with AUR was established in October 2007. Prospective data collected in 194 ambulatory patients from January to December 2008 were compared to a historical cohort of 168 patients who were managed by in-patient care from October 2006 to September 2007 for their clinical and economic outcomes.

Results

For the historical cohort, the mean length of hospital stay was 4.67?±?3.34?days and the trial without catheterization (TWOC) success rate was 66.1?%. Two patients (1.2?%) developed dizziness after using ??₁-blockers. For the patients in the ambulatory care program, the mean duration of catheterization was 4.72?±?2.26?days and the TWOC success rate was 69.1?%. There were four unplanned admissions (2.1?%) among the patients who were managed under the ambulatory care program; three of them had catheter-related complications (i.e., hematuria and urinary tract infection) and one developed dizziness after the use of alfuzosin. All of them were managed accordingly and no unfavorable sequelae were resulted. This new program reduced hospital admission rate of male patients presenting with AUR by 59.1?%. It leads to significant cost reduction of USD 375,614.3 in our hospital in year 2008.

Conclusion

The ambulatory care program reduced the hospital admission rate and reduced cost without jeopardizing the TWOC success rate and safety in the management of patients presenting with AUR.     

慢性前列腺炎在前列腺增生症发病与进展中的作用探讨

目的 探讨慢性前列腺炎在前列腺增生症发病与进展中的可能作用.方法 回顾性分析本院2011年5月至2014年12月期间因前列腺增生就诊患者356例,根据术后病理结果分为前列腺增生并慢性前列腺炎组及单纯性前列腺增生组,统计分析两组临床特征,包括:年龄(Age)、前列腺体积(PV)、PSA、IPSS评分、是否合并急性尿潴留(AUR).结果 前列腺增生并慢性前列腺炎121/356例(34.0％),发生急性尿潴留48/121例(39.7％);单纯前列腺增生235/356例(66.0％),发生尿潴留60/235例(25.5％).两组对比年龄差别无统计学意义(P＞0.05);但前列腺增生合并慢性前列腺炎组较单纯前列腺增生组PV、PSA、IPSS评分、尿潴留发生率均高,差别具有统计学意义(P＜0.05).结论 前列腺增生合并慢性前列腺炎通常具有更大的体积、更高的PSA及IPSS评分、更易发生尿潴留.因此,前列腺慢性炎症在前列腺增生的发病、进展中可能起作用.     

良性前列腺增生症急性尿潴留的临床预测

目的 应用临床常用指标，预测良性前列腺增生(BPH)发生急性尿潴留(AUR)的几率。方法 回顾78名BPH患者病史，分为曾发生AUR(A组)28例，从未发生AUR(B组)50例。分别比较两组间在前列腺总体积(PV)、前列腺移行区体积(TZV)、移行区指数(TZI)和前列腺特异抗原(PSA)、游离前列腺特异抗原(F-PSA)、游离与总前列腺特异抗原比值(F/T-PSA)等指标上的差异性，寻找其中能用于预测AUR的临床指标。应用ROC曲线即受试者工作特性曲线，确定相关指标预测AUR的分界值。结果 A组平均PV、TZV和PSA值皆明显高于B组，上述3个指标在A、B两组间存在显著性差异。而A、B两组在年龄、TZI、F-PSA、F/T-PSA上都无显著性差异。在预测AUR方面PSA可能比前列腺体积指标更具临床价值。结论 可通过PV、TZV及PSA来预测BPH中AUR的发生。根据不同临床需要确定预测AUR的临界值，有利于及早对BPH高危人群进行监控和治疗干 预。     

Low incidence of acute urinary retention in the general male population: the triumph project

OBJECTIVE: To describe the incidence of acute urinary retention (AUR) in the general male population and in a population of men newly diagnosed with lower urinary tract symptoms suggestive of BPH (LUTS/BPH). METHODS: We performed a retrospective cohort study in the Integrated Primary Care Information (IPCI) database, a GP research database in The Netherlands, during the period 1995-2000. All males, > or =45 years, without a history of AUR or radical cystectomy were included in the study. In addition, we followed a sub-cohort of men, newly diagnosed with LUTS/BPH. AUR was defined as the sudden inability to urinate, requiring catheterization. RESULTS: Amongst 56,958 males with a mean follow-up of 2.8 years, 344 AUR cases occurred (incidence rate 2.2/1000 man-years) of whom more than 40% were precipitated. AUR was the first symptom of LUTS/BPH in 73 (49%) of the 149 AUR cases that occurred in men newly diagnosed with LUTS/BPH. The risk of AUR was 11-fold higher in patients newly diagnosed with LUTS/BPH (RR 11.5; 95%CI: 8.4-15.6) with an overall incidence rate of 18.3/1000 man-years (95%CI: 14.5-22.8). CONCLUSIONS: The incidence rate of AUR is low in the general population but substantial in a population of men newly diagnosed with LUTS/BPH. The incidence rate increases with age and AUR is precipitated in approximately 40% of all cases. Within the LUTS/BPH cohort, AUR is the first presenting symptom of BPH in 50% of all AUR cases.