K L Lo1, M C K Chan, A Wong, S M Hou, C F Ng. 1. Division of Urology, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
Abstract
OBJECTIVE: To perform a retrospective review of long-term outcome for patients with a first episode of acute urinary retention (AUR) who could void successfully after the initial trial without catheter (TWOC) after treatment with an alpha-adrenergic receptor blocker (AR blocker). METHODS: The records of 248 patients who presented with a first episode of AUR secondary to benign prostatic hyperplasia (BPH) and who could void successfully after the initial TWOC following treatment with an AR blocker were reviewed during the period January 1998 to December 2001. The characteristics of the patients and the subsequent outcomes were recorded. The primary outcome assessed was failed medical treatment within the five-year follow-up period. Factors correlated with the primary outcome were also assessed. RESULTS: For these 248 patients, the median follow-up time was 33.0 months (range 0-96 months). The percentage of patients with failed medical treatment at 6, 12, 24, and 60 months was 11.6, 14.3, 28.4, and 50.5%, respectively. Multivariate analysis indicated that only a prostate size >50 ml and serum prostate specific antigen (PSA) level during AUR >10 ng/dl were significant predictors of subsequent requirement for surgical intervention after a successful TWOC. CONCLUSIONS: Although AR blockers increased the success rate of TWOC, approximately half of the patients in this study still required additional intervention within five years. By using appropriate selection criteria, such as a large prostate size (>50 ml) or high serum PSA level during AUR (>10 microg/l), patients who are at greater risk of TWOC failure can be identified, and earlier surgical intervention can be offered to them.
OBJECTIVE: To perform a retrospective review of long-term outcome for patients with a first episode of acute urinary retention (AUR) who could void successfully after the initial trial without catheter (TWOC) after treatment with an alpha-adrenergic receptor blocker (AR blocker). METHODS: The records of 248 patients who presented with a first episode of AUR secondary to benign prostatic hyperplasia (BPH) and who could void successfully after the initial TWOC following treatment with an AR blocker were reviewed during the period January 1998 to December 2001. The characteristics of the patients and the subsequent outcomes were recorded. The primary outcome assessed was failed medical treatment within the five-year follow-up period. Factors correlated with the primary outcome were also assessed. RESULTS: For these 248 patients, the median follow-up time was 33.0 months (range 0-96 months). The percentage of patients with failed medical treatment at 6, 12, 24, and 60 months was 11.6, 14.3, 28.4, and 50.5%, respectively. Multivariate analysis indicated that only a prostate size >50 ml and serum prostate specific antigen (PSA) level during AUR >10 ng/dl were significant predictors of subsequent requirement for surgical intervention after a successful TWOC. CONCLUSIONS: Although AR blockers increased the success rate of TWOC, approximately half of the patients in this study still required additional intervention within five years. By using appropriate selection criteria, such as a large prostate size (>50 ml) or high serum PSA level during AUR (>10 microg/l), patients who are at greater risk of TWOC failure can be identified, and earlier surgical intervention can be offered to them.
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