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.