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.