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Christensen VS, Skow M, Flottorp SA, Strømme H, Mdala I, Vallersnes OM. Immediate or delayed trial without catheter in acute urinary retention in males: A systematic review. BJUI COMPASS 2024; 5:732-747. [PMID: 39157169 PMCID: PMC11327489 DOI: 10.1002/bco2.369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/05/2024] [Accepted: 04/17/2024] [Indexed: 08/20/2024] Open
Abstract
Objective To compare the success of establishing spontaneous micturition following immediate trial without catheter (TWOC) to delayed TWOC in males catheterized for acute urinary retention. Materials and methods In this systematic review, we included studies reporting success rates of immediate TWOC or delayed TWOC (≤30 days) among males ≥18 years of age catheterized for acute urinary retention. We excluded studies on suprapubic catheterization, postoperative/perioperative catheterization and urinary retention related to trauma. We searched the following databases: MEDLINE, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Open Grey and Clinicaltrials.gov. The search was concluded on 30 November 2022. There were no restrictions on language or publication date. Risk of bias was assessed using the ROB 2.0 and ROBINS-I tools. We did random-effects restricted maximum likelihood model meta-analyses. Certainty of evidence was assessed using GRADE. Results We included 61 studies. In two randomized controlled trials (RCTs), both with some concerns for risk of bias, including in total 174 participants, the relative success rate was 1.22 (95% CI 0.84-1.76) favouring delayed TWOC. In two comparative cohort studies, both with serious risk of bias, including 642 participants, the relative success rate was 1.18 (0.94-1.47) favouring delayed TWOC. One study was excluded from this meta-analysis because of critically low quality. Four studies reporting success rates for cohorts with immediate TWOC, all with serious risk of bias, including 409 participants, had an overall success rate of 47% (29-66). Fifty-two studies reporting success rates for cohorts with delayed TWOC, all with serious risk of bias, including 12 489 participants, had an overall success rate of 53% (49-56). The certainty of the evidence was considered low for the RCTs and very low for the rest. Conclusion There was a limited number of appropriately designed studies addressing the research question directly. The evidence favours neither approach.
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Affiliation(s)
| | - Marius Skow
- The Antibiotic Centre for Primary CareUniversity of OsloOsloNorway
- Oslo Accident and Emergency Outpatient ClinicCity of Oslo Health AgencyOsloNorway
| | - Signe A. Flottorp
- Department of General PracticeUniversity of OsloOsloNorway
- Division of Health ServicesNorwegian Institute of Public HealthOsloNorway
| | - Hilde Strømme
- Library of Medicine and ScienceUniversity of OsloOsloNorway
| | - Ibrahimu Mdala
- Department of General PracticeUniversity of OsloOsloNorway
| | - Odd Martin Vallersnes
- Oslo Accident and Emergency Outpatient ClinicCity of Oslo Health AgencyOsloNorway
- Department of General PracticeUniversity of OsloOsloNorway
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Hsu TS, Weng SC, Lin YH, Chen CL, Tsao SH, Tsai HY, Juang HH, Chang PL, Hou CP. Surgical outcomes of endoscopic enucleation of the prostate in community aging males with or without preoperative urinary retention. Int Urol Nephrol 2024; 56:2513-2519. [PMID: 38564078 PMCID: PMC11266197 DOI: 10.1007/s11255-024-04007-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/26/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES This study aims to investigate the surgical outcomes of endoscopic enucleation of the prostate in older males with or without preoperative urinary retention (UR). MATERIAL AND METHODS We conducted a study on selected patients with symptomatic benign prostatic hyperplasia (BPH) who underwent either thulium:YAG laser (vela XL) prostate enucleation (ThuLEP) or bipolar plasma enucleation of the prostate (B-TUEP) at the geriatric urology department of our institution. The studied patients were categorized into two groups, namely the UR group and the non-UR group, on the basis of whether they experienced UR in the 1 month preceding their surgery. Their clinical outcomes following prostate endoscopic surgery were evaluated and analyzed. RESULTS Our results revealed comparable outcomes for operation time, length of hospital stay, percentage of tissue removed, re-catheterization rate, and urinary tract infection rate within the 1 month between the B-TUEP and ThuLEP surgery groups, regardless of UR history. However, the non-UR B-TUEP group experienced more blood loss relative to the non-UR ThuLEP group (P = .004). Notably, patients with UR exhibited significantly greater changes in IPSS total, IPSS voiding, and prostate-specific antigen values relative to those without UR. CONCLUSIONS Both ThuLEP and B-TUEP were effective in treating BPH-related bladder outlet obstruction. Our study identified more pronounced changes in IPSS total, IPSS voiding, and prostate-specific antigens within the UR group. Moreover, the rate of postoperative UR in this group was not higher than that observed in the non-UR group. Our study also revealed that the presumed benefits of laser surgery in reducing blood loss were less pronounced for patients with UR.
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Affiliation(s)
- Tung-Shiun Hsu
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan, 333, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Shu-Chuan Weng
- Department of Health and Management, Yuanpei University of Medical Technology, Hsinchu, 330, Taiwan
- Bachelor Degree Program of Senior Health and Management, Yuanpei University of Medical Technology, Hsinchu, 330, Taiwan
| | - Yu-Hsiang Lin
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan, 333, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Chien-Lun Chen
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan, 333, Taiwan
| | - Shu-Han Tsao
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan, 333, Taiwan
| | - Han-Yu Tsai
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan, 333, Taiwan
| | | | - Phei-Lang Chang
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan, 333, Taiwan
| | - Chen-Pang Hou
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan, 333, Taiwan.
- Department of Health and Management, Yuanpei University of Medical Technology, Hsinchu, 330, Taiwan.
- School of Medicine, Chang Gung University, Taoyuan, 333, Taiwan.
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Abuelnaga M, Elawady H, Mahmoud MA, Mostafa D, Samir M. Does the duration of catheterization have an impact on the outcome of trial without catheter in patients with acute urine retention (AUR) due to benign prostatic hyperplasia (BPH)? A prospective randomized study. Urologia 2024; 91:107-111. [PMID: 38044812 DOI: 10.1177/03915603231215936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
BACKGROUND To study the impact of early in comparison to late catheter removal following acute urine retention (AUR) secondary to benign prostatic hyperplasia (BPH) using silodosin therapy on the outcome of trial without catheter (TWOC). METHODS Two hundred sixty patients with AUR 2ry to BPH were catheterized then were randomly divided to receive silodosin 8 mg either for three or 7 days followed by catheter removal and successful voiding unaided was assessed. RESULTS Out of the 260 men (mean age 64.8 ± 6.5 years) treated, 74 men who were receiving 3 days of silodosin and 88 patients who were receiving 7 days of silodosin didn't require re-catheterization on the day of TWOC (57% and 68% respectively, p = 0.096). Complications like urinary leakage, acute urinary tract infection, hematuria, or catheter blockage recorded in 21 men (16.2%) who received 3 days of silodosin, and in 63 men (48.5%) who received 7 days of silodosin (p ⩽ 0.001). CONCLUSION Patients catheterized after AUR 2ry to BPH can spontaneously void following catheter removal if treated by silodosin, independent of the catheterization duration, while side effects have increased with prolonged catheterization.
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Affiliation(s)
- Mohamed Abuelnaga
- Faculty of Medicine, Department of Urology, Ain Shams University Hospitals, Cairo, Egypt
| | - Hossam Elawady
- Faculty of Medicine, Department of Urology, Ain Shams University Hospitals, Cairo, Egypt
| | - Mahmoud A Mahmoud
- Faculty of Medicine, Department of Urology, Ain Shams University Hospitals, Cairo, Egypt
| | - Diaa Mostafa
- Faculty of Medicine, Department of Urology, Ain Shams University Hospitals, Cairo, Egypt
| | - Mohamed Samir
- Faculty of Medicine, Department of Urology, Ain Shams University Hospitals, Cairo, Egypt
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4
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Rochester M, Doherty R, Page T, Barber N, Kavia R, Thiruchelvam N, Gange S, Mueller T, Eure G, Chin P, Kayes O. Prostatic urethral lift for subjects in urinary retention (PULSAR): 12-Month results of a prospective controlled trial compared with real-world outcomes. BJUI COMPASS 2024; 5:60-69. [PMID: 38179018 PMCID: PMC10764167 DOI: 10.1002/bco2.280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 01/06/2024] Open
Abstract
Objective To examine the safety and efficacy of prostatic urethral lift (PUL) in acute urinary retention (AUR) patients within a controlled (PULSAR) and real-world setting (Real-World Retrospective study). Materials and methods PULSAR was a 12-month prospective study of PUL in AUR patients (n = 51) performed at six centres in the United Kingdom; enrolled BPH patients aged ≥50 years, with prostate volume of ≤100 cc. AUR was defined as being catheter dependent with at least one prior failed trial without catheter (TWOC) while on an alpha-blocker. RWR consisted of 3226 consecutive PUL patients across 22 international sites treated between July 2017 and March 2020; 469 of whom were in urinary retention (RWRr), that is, catheter-dependent at the time of their procedure. Symptom response, uroflow and catheter independence rates were compared between PULSAR and RWRr subjects. A logistical regression model was constructed to evaluate patient baseline and dynamic factors predicting success after the procedure. Results Seventy-three percent of PULSAR subjects were catheter independent and free from surgical reintervention at 12 months post-PUL. Success was associated with higher voiding efficiency during the perioperative period. Slightly higher catheter-independent rates (80%) were seen in RWRr patients; variables that influenced success included age <70 years, lower baseline prostate-specific antigen (PSA), lower baseline post-void residual (PVR) and shorter pre-procedural catheter duration. Logistic regression of the combined PULSAR and RWRr retention groups revealed that procedural age <70 years and higher bladder voiding efficiency (BVE) were associated with success. Conclusions Lower baseline PSA and PVR, younger age and shorter pre-procedure catheter durations drove successful outcomes in AUR patients undergoing PUL. Post-PUL voiding efficiencies may help ascertain long-term response to treatment.
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Affiliation(s)
| | - Ruth Doherty
- Norfolk and Norwich University HospitalNorwichUK
| | - Toby Page
- Freeman HospitalNewcastle upon TyneUK
| | | | | | | | | | | | - Gregg Eure
- Urology of VirginiaVirginia BeachVirginiaUSA
| | - Peter Chin
- South Coast UrologyWollongongNew South WalesAustralia
| | - Oliver Kayes
- Leeds Teaching Hospitals and University of LeedsLeedsUK
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5
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Ivanuta M, Puia D, Pricop C. Elements for Trial Without Catheter (TWOC) Success in Benign Prostatic Hyperplasia Patients: Lessons We Have Learned. Cureus 2023; 15:e50980. [PMID: 38259407 PMCID: PMC10801439 DOI: 10.7759/cureus.50980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Benign prostatic hyperplasia (BPH) is a progressive disease that causes low urinary tract symptoms (LUTS). As prostatic volume grows, the prostatic urethra may become completely obstructed, resulting in full urine retention and acute hypogastric pain. Our research aimed to identify the optimal trial without catheter (TWOC) therapeutic approach and identify those factors that are associated with the recurrence of complete urinary retention (CUR). METHODOLOGY The study enrolled with complete urinary retention and BPH were included in the study, after the insertion of a Foley catheter. The patients received tamsulosin 0.4 mg/day as an alpha-blocker treatment. In our investigation, patients who encountered complete urinary retention were randomly categorized into four groups based on the duration of urinary catheterization as determined by the attending urologist. RESULTS Maintaining the urethrovesical catheter for three to seven days was related to the highest success of spontaneous urination, which was statistically significant compared to other study groups. (p=0.0007). Age over 70 years, no alpha-blocker before the urinary retention episode, and prostatic volume exceeding 50 ml were all associated with decreased TWOC efficacy. We found the highest rates of spontaneous urination were after three to seven days of urinary catheterization. CONCLUSION BPH and complete urine retention can be managed by TWOC in many cases. Several factors affect the test's efficacy. Prolonged urinary catheter maintenance over seven days, prostatic volume over 50 ml, and age over 70 years are poor prognostic indicators.
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Affiliation(s)
| | - Dragos Puia
- Urology, University for Medicine and Pharmacy "Grigore T. Popa", Iasi, ROU
| | - Catalin Pricop
- Urology, University for Medicine and Pharmacy "Grigore T. Popa", Iași, ROU
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6
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Baran C. The effect of acute urinary retention on the results of transurethral resection of the prostate. Urologia 2023; 90:642-646. [PMID: 37491943 DOI: 10.1177/03915603231189627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
INTRODUCTION Acute urinary retention (AUR) is one of the most severe symptoms of Benign Prostatic Hyperplasia (BPH). There are some studies in the literature describing the risk factors for the development of AUR in BPH patients. However, the studies that summarize the effect of AUR on Transurethral resection of Prostate (TUR-P) surgery results are limited. The aim of this study is to assess the effect of AUR on TUR-P results. METHODS Between 2018 and 2020, patients who underwent TUR-P for AUR or lower urinary tract symptoms (LUTS) were included in the study. The inclusion criteria were, men over 50 years old with a BPH diagnosis and who underwent monopolar TUR-P by a single surgeon. The exclusion criteria were; patients who had prostate cancer, multiple sclerosis, or neurogenic bladder were diagnosed or had previous lower urinary tract surgeries such as TUR-P, TUR-Bladder, Urethrotomy, had a chronic indwelling catheter, and patients who did not accept immediate TUR-P and preferred trial without catheter (TWOC) protocol. The age, PSA, prostate volume, pre- and post-operative flow rates, duration of hospitalization, and complications were recorded. Two groups were constituted for comparison such as AUR and Elective Group and p values <0.05 were considered significant. RESULTS There were 14 and 46 patients for AUR and Elective Groups respectively. The age, pre-operative prostate volume, free and total PSA values, postoperative complication rate, and re-hospitalization rate were significantly higher in the AUR-Group. However, there were no differences between groups in terms of pre-operative medication, duration of hospitalization, and post-operative uroflow maximum flow rate. DISCUSSION Patients who underwent TUR-P after AUR have a higher risk for complications and re-hospitalization. Care should be taken in these patients and patients should be warned about the risks.
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Affiliation(s)
- Caner Baran
- Çukurova State Hospital, Department of Urology, Adana, Turkey
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7
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Takanashi M, Ito H, Fukazawa T, Takizawa H, Hioki M, Shinoki R, Kawahara T, Kobayashi K. Predictive factors for the success of trial without catheter for men with urinary retention. Low Urin Tract Symptoms 2023; 15:173-179. [PMID: 37278133 DOI: 10.1111/luts.12492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/25/2023] [Accepted: 05/25/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To investigate the trial of spontaneous urination without catheter (TWOC) outcomes for men with acute urinary retention, determine successful TWOC predictors, and evaluate the impact of add-on medication therapy on TWOC. METHODS This retrospective study included men with acute urinary retention and post-void residual (PVR) >250 mL who underwent TWOC between July 2009 and July 2019. Patients were divided into a medicated group who received alpha1 blocker on urinary retention diagnosis and a naïve group who did not. The trial was defined as unsuccessful if the PVR was >150 mL or if the patient experienced difficulty emptying their bladder with abdominal discomfort or pain, and a transurethral catheter was reinserted. RESULTS Among 576 men with urinary retention, 269 (46.7%) constituted the medicated group and 307 (53.3%) the naïve. The naïve group comprised more elderly patients (P = 0.010) with higher Eastern Cooperative Oncology Group performance status (PS) (P = 0.001) and smaller prostate volume (P = 0.028) than the other. In the medicated group, 153 men received additional oral medication before TWOC to increase the success rate. There were significant age differences (P = 0.041) in the medicated group and significant median PS differences (P = 0.010) in the naïve group between the successful and unsuccessful outcomes of TWOC. The multivariate logistic regression model demonstrated that age <80 years in medicated patients (P = 0.042, odds ratio [OR] 1.701) and PS <2 in naïve patients (P = 0.001, OR 2.710) were significant independent predictors of successful TWOC outcomes. CONCLUSIONS This is the first study classifying patients with urinary retention according to medication status. Both medicated and naïve groups had different patient backgrounds and TWOC outcome predictors, suggesting a discrepant etiology behind urinary retention. Hence, acute urinary retention management in men should vary based on medication status for male lower urinary tract symptoms when urinary retention is diagnosed.
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Affiliation(s)
- Masato Takanashi
- Department of Urology, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Hiroki Ito
- Department of Urology, Yokosuka Kyosai Hospital, Yokosuka, Japan
- Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Takeshi Fukazawa
- Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hiroki Takizawa
- Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Mari Hioki
- Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Risa Shinoki
- Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Takashi Kawahara
- Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kazuki Kobayashi
- Department of Urology, Yokosuka Kyosai Hospital, Yokosuka, Japan
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Ghazanfar NA, Rasheed A, Shah AA, Bhatti SA, Sohail H, Farooq A. Impact of Duration of Catheterization on the Success Rate of Trial Without Catheter in Acute Urinary Retention Due to Benign Prostatic Enlargement. Cureus 2023; 15:e42716. [PMID: 37654938 PMCID: PMC10466170 DOI: 10.7759/cureus.42716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND The most common cause of acute urinary retention in men over 50 is benign prostate enlargement (BPE). Following the urethral catheterization, a trial without a catheter (TWOC) under the cover of alpha-blockers is given. The timing of TWOC varies from Day 3 to Day 7 of the retention episode. There is a need to study the improvement in the success rate of TWOC with the increasing number of days of catheterization. OBJECTIVE To measure the success rate of TWOC in acute urinary retention due to benign prostatic enlargement with increasing days of catheterization. METHOD The study was conducted in Social Security Teaching Hospital Lahore. Patients who presented with acute urinary retention due to benign prostatic enlargement were catheterized and given alpha-blockers. The patients were divided into two groups, one group having TWOC after three days and the other having TWOC after seven days. The success rate of TWOC was calculated and compared in the two groups. All patients included in the study had the first episode of acute retention with a moderately enlarged prostate and no element of second pathology or neurological deficit. RESULTS A total of 48 patients were included in the study, divided into two groups of 24 patients each. In the first group who underwent TWOC after seven days of catheterization, 15 out of 24 patients had successful TWOC with a success rate of 62.5%. In the second group of 24 patients, who had TWOC after three days of catheterization, only 11 patients had successful TWOC with a success rate of 45.8%. CONCLUSION There was a marked improvement in the success rate of TWOC with increasing days of catheterization after an acute retention episode, secondary to BPE.
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Affiliation(s)
- Noman Ali Ghazanfar
- Urology, University College of Medicine and Dentistry/Social Security Teaching Hospital, Lahore, PAK
| | - Abdur Rasheed
- Urology, Central Park Medical College and Teaching Hospital, Lahore, PAK
| | | | | | - Hassan Sohail
- Urology, University College of Medicine and Dentistry/Social Security Teaching Hospital, Lahore, PAK
| | - Abid Farooq
- Urology, Blackpool Victoria NHS (National Health Services) Trust Hospital, Blackpool, GBR
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9
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Corral R, Boissier R, Depaquit TL, Gondran-Tellier B, Bastide C, Lechevallier E, Baboudjian M. Saline bladder infusion vs standard catheter removal in patients with acute urinary retention related to benign prostatic hyperplasia: The BLAPERF Study. Prog Urol 2023; 33:319-324. [PMID: 36842924 DOI: 10.1016/j.purol.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/19/2022] [Accepted: 02/10/2023] [Indexed: 02/28/2023]
Abstract
PURPOSE Bladder infusion, which involves filling the bladder with saline prior to catheter removal, has been associated with reduced time-to-discharge and increased success rates in trials without catheter (TWOCs) in perioperative setting. The objective of this study was to evaluate the applicability of this protocol in patients with acute urinary retention (AUR) related to benign prostatic hyperplasia (BPH). METHODS We conducted a retrospective single-center study comparing bladder infusion with at least 150mL of warm saline vs. standard catheter removal during TWOC in patients with BPH-related AUR between January and December 2021. The primary outcome was time to discharge. Secondary outcomes included: TWOC success, and early recurrence of urinary retention defined as recurrence within three months of successful TWOC. RESULTS A total of 75 men were included: 35 in the bladder infusion protocol and 40 in the standard protocol. Baseline characteristics were well balanced between groups. Overall, 35 patients (46.7%) had a successful TWOC without statistically significant difference between groups (P=0.10). Bladder infusion protocol was associated with a shorter median time to discharge (200 vs. 240min, P=0.003). However, patients in the bladder infusion group were associated with a higher risk of early recurrence of urinary retention (30% vs. 0%, P=0.02). CONCLUSION In patients with BPH-related AUR, the saline bladder infusion method reduced time-to-discharge with similar TWOC success rates. Larger studies are needed to properly analyze the risk of early recurrence of urinary retention before any clinical application. LEVEL OF EVIDENCE III.
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Affiliation(s)
- R Corral
- Department of Urology, La Conception Hospital, Assistance publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - R Boissier
- Department of Urology, La Conception Hospital, Assistance publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - T L Depaquit
- Department of Urology, La Conception Hospital, Assistance publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - B Gondran-Tellier
- Department of Urology, La Conception Hospital, Assistance publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - C Bastide
- Department of Urology, North Hospital, Assistance publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - E Lechevallier
- Department of Urology, La Conception Hospital, Assistance publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - M Baboudjian
- Department of Urology, La Conception Hospital, Assistance publique-Hôpitaux de Marseille (AP-HM), Marseille, France; Department of Urology, North Hospital, Assistance publique-Hôpitaux de Marseille (AP-HM), Marseille, France.
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10
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Long-term outcomes of prostate artery embolization for acute urinary retention: An analysis of 88 patients. Diagn Interv Imaging 2023; 104:292-296. [PMID: 36801097 DOI: 10.1016/j.diii.2023.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/27/2023] [Accepted: 01/31/2023] [Indexed: 02/18/2023]
Abstract
PURPOSE The purpose of this study was to assess long-term outcome of prostate artery embolization (PAE) in patients presenting with acute urinary retention related to benign prostatic hyperplasia. MATERIALS AND METHODS All consecutive patients who underwent PAE for acute urinary retention due to benign prostatic hyperplasia from August 2011 to December 2021 in a single institution were retrospectively included. There were 88 men with a mean age of 72 ± 12 (standard deviation [SD]) years (range: 42-99 years). Patients underwent a first attempt of catheter removal two weeks after PAE. Clinical success was defined as the absence of acute urinary retention recurrence. Correlations between long-term clinical success and patient variables or bilateral PAE were searched for using Spearman correlation test. Catheter-free survival was assessed using Kaplan-Meier analysis. RESULTS Successful catheter removal in the month following PAE was performed in 72 (72/88; 82%) patients and 16 (16/88; 18%) patients had immediate recurrence. Clinical success persisted for 58 (58/88; 66%) patients at long-term follow-up (mean follow-up: 19.5 months ± 16.5 [SD]; range: 2-74 months). Recurrence occurred at a mean of 16.2 months ± 12.2 (SD) (range: 1.5-43 months) post-PAE. Overall, 21 (21/88; 24%) patients of the cohort underwent prostatic surgery, at a mean of 10.4 months ± 12.2 (SD) (range: 1.2-42.4 months) from initial PAE. No correlations between patients variables or bilateral PAE and long-term clinical success were identified. Kaplan-Meier analysis showed a three-year catheter free probability of 60%. CONCLUSION PAE is a valuable technique for acute urinary retention related to benign prostatic hyperplasia, with a long-term success rate of 66%. However acute urinary retention relapse affects 15% of patients.
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Tadrist A, Baboudjian M, Bah MB, Alegorides C, Bottet F, Arroua F, Eghazarian C, Fourmarier M. Water vapor thermal therapy for indwelling urinary catheter removal in frail patients. Int Urol Nephrol 2023; 55:249-253. [PMID: 36342555 DOI: 10.1007/s11255-022-03408-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/01/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE To report the efficacy and safety of water vapor thermal therapy to achieve catheter removal in frail patients with refractory acute urinary retention. METHODS Data from consecutive frail patients with indwelling urinary catheter undergoing the Rezūm™ therapy (Boston Scientific Corporation, Marlborough, MA) at a single center between October 2017 and June 2021 were prospectively collected. The included patients were deemed unfit or at high risk of complications for conventional benign prostatic hyperplasia (BPH) surgery. Prostate volumes up to 120 mL were considered eligible. The primary endpoint was successful cessation of catheter dependency, assessed postoperatively and up to 1 year of follow-up. RESULTS A total of 24 men met our inclusion criteria. The median age, Charlson comorbidity index, and duration of preoperative catheterization were 77 years (IQR 67-86), 6 (IQR 3-7), and 113 days (IQR 87-159), respectively. Two cases (8.3%) of postoperative complications were recorded (Clavien II and Clavien IIIa). After a median postoperative catheterization time of 21 days (IQR 11-32), all patients regained spontaneous voiding. During follow-up, two patients died and a total of 22 patients completed the 1 year follow-up. All patients maintained spontaneous voiding without recurrence of urinary retention. No surgical retreatment was performed. In terms of pharmacological management, 22/24 patients (91.7%) had a BPH medication pre-Rezūm™; this decreased to 8/22 patients (36.3%) post-Rezūm™ (p < 0.001). CONCLUSIONS In this single-institution, prospective, and observational study, water vapor thermal therapy was found to be effective and safe in restoring successful spontaneous voiding in a cohort of elderly and frail patients.
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Affiliation(s)
- Abel Tadrist
- Department of Urology, CH Aix-Pertuis, Aix en Provence, France
| | - Michael Baboudjian
- Department of Urology, CH Aix-Pertuis, Aix en Provence, France. .,Department of Urology, North Hospital, Aix-Marseille University, APHM, Marseille, France. .,Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain.
| | - Mamadou B Bah
- Department of Urology, CH Aix-Pertuis, Aix en Provence, France.,Department of Urology, Hôpital National Ignace Deen, Conakry, Republic of Guinea
| | | | - Florie Bottet
- Department of Urology, CH Aix-Pertuis, Aix en Provence, France
| | - Frederic Arroua
- Department of Urology, CH Aix-Pertuis, Aix en Provence, France
| | | | - Marc Fourmarier
- Department of Urology, CH Aix-Pertuis, Aix en Provence, France
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12
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Bengtsen MB, Heide-Jørgensen U, Borre M, Knudsen JS, Nørgaard M. Acute urinary retention in men: 21-year trends in incidence, subsequent benign prostatic hyperplasia-related treatment and mortality: A Danish population-based cohort study. Prostate 2023; 83:87-96. [PMID: 36128607 PMCID: PMC10087475 DOI: 10.1002/pros.24440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 08/03/2022] [Accepted: 08/26/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To examine trends in incidence of acute urinary retention, subsequent benign prostatic hyperplasia-related treatment and mortality in the era of medical therapy for benign prostatic hyperplasia. Additionally, to compare mortality with the general population. MATERIALS AND METHODS We conducted a Danish nationwide registry-based study including 70,775 men aged 45 years or older with a first hospitalization for acute urinary retention during 1997-2017. We computed annual standardized incidence rates, subsequent 1-year cumulative incidence of benign prostatic hyperplasia-related surgical and medical treatment, and standardized 3-month and 1-year mortality rates. Finally, we compared standardized all-cause and cause-specific mortality ratios with the general population. RESULTS The standardized incidence rate of acute urinary retention per 1000 person-years increased transiently from 2.34 to 3.42 during 1997-2004, but gradually declined to 2.95 in 2017. The 1-year cumulative incidence of benign prostatic hyperplasia-related surgery declined from 31.2% to 19.8% and 20.5% to 7.7% after spontaneous and precipitated acute urinary retention, respectively. During 1997-2017, the standardized 1-year mortality declined from 22.2% to 17.2%. Compared with the general population, mortality was 4-5 times higher after 3 months and 2-3 times higher after 1 year of acute urinary retention. The cause-specific standardized mortality ratios were particularly high for deaths attributable to malignancies, urogenital disease, certain infections, chronic pulmonary disease, and diabetes. CONCLUSION During 1997-2017, we observed a transient increase in the incidence of acute urinary retention. The subsequent use of benign prostatic hyperplasia-related surgery declined considerably and mortality continued to be high, mainly because of deaths from malignancies, urogenital disease, infections, and preexisting comorbidity.
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Affiliation(s)
| | - Uffe Heide-Jørgensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Borre
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - Jakob S Knudsen
- Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark
| | - Mette Nørgaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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13
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Takanashi M, Ito H, Fukazawa T, Shinoki R, Tabei T, Kawahara T, Kobayashi K. Predictive factors for the success of trial catheter removal for women with urinary retention. Low Urin Tract Symptoms 2023; 15:4-10. [PMID: 36252953 DOI: 10.1111/luts.12464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 09/17/2022] [Accepted: 10/03/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To investigate the outcome, determine the predictors for the success of, and evaluate the efficacy of pharmacokinetic therapy on trial catheter removal for women with urinary retention. METHODS Inclusion criteria were female patients with acute urinary retention defined as painful, palpable, or percussive bladder, when the patient is unable to pass any urine, accompanied by postvoid residual (PVR) > 250 ml, and who underwent trial catheter removal between July 2009 and July 2019. Before trial catheter removal, alpha-blockers alone or alpha-blockers and parasympathomimetics (bethanechol or distigmine bromide) were used to facilitate spontaneous voiding in some cases. RESULTS Fifty-nine of 104 (56.7%) women with urinary retention were catheter-free post trial. There was no significant difference between successful and non-successful trials in average age (p = .392), median ECOG (Eastern Cooperative Oncology Group) performance status (p = .374), diabetes mellitus (p = .842), dementia (p = .801), previous history of cerebrovascular events (p = .592), or intrapelvic surgery (p = .800). Oral medications were administered for 39/59 (66.1%) in the success group and 30/45 (66.7%) patients in the non-success groups (p = .598). Serum albumin (3.2 ± 0.7 g/dl and 2.8 ± 0.8 g/dl, p = .039) and total protein values (6.5 ± 0.8 g/dl and 6.0 ± 1.0 g/dl, p = .038) at diagnosis of urinary retention were higher in the success group than the non-success group, respectively. Multivariate logistic regression found that a serum albumin >3 g/dl was an independent predictor of successful trial catheter removal for women with urinary retention (p = .030, odds ratio [OR] 3.3, 95% confidence interval [CI] of OR 1.1-9.9). Age < 70 years old was a likely predictor of successful trial catheter removal (p = .066, OR 4.8, 95% CI of OR 0.9-25.0). CONCLUSIONS This is the first retrospective study to investigate the predictive factors for successful trial catheter removal in women with urinary retention. A serum albumin value >3 mg/dl at diagnosis of urinary retention was a significant independent predictor of catheter-free status after trial catheter removal, and age < 70 years-old was a possible contributor. There was no evidence that oral medication contributed to catheter-free status.
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Affiliation(s)
- Masato Takanashi
- Department of Urology, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Hiroki Ito
- Department of Urology, Yokosuka Kyosai Hospital, Yokosuka, Japan
- Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Takeshi Fukazawa
- Department of Urology, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Risa Shinoki
- Department of Urology, Yokosuka Kyosai Hospital, Yokosuka, Japan
- Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Tadashi Tabei
- Department of Urology, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Takashi Kawahara
- Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kazuki Kobayashi
- Department of Urology, Yokosuka Kyosai Hospital, Yokosuka, Japan
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14
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Baboudjian M, Boissier R. Parcours de soin de la rétention aiguë d’urines. Prog Urol 2022; 32:875-879. [DOI: 10.1016/j.purol.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 08/01/2022] [Indexed: 11/06/2022]
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15
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McNaughton J, Fairley-Murdoch M. Catheter valves: are they useful in supporting patients in a trial without catheter? Br J Community Nurs 2022; 27:294-300. [PMID: 35671208 DOI: 10.12968/bjcn.2022.27.6.294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A trial without catheter (TWOC) is a common urological procedure undertaken to remove an indwelling urinary catheter when no longer clinically indicated. An appropriately trained practitioner should undertake a TWOC in a controlled environment to ensure that a further urinary retention does not occur. Indwelling urinary catheters are commonly used with a free drainage system such as a leg bag, which continually empties the bladder. This article examines the potential benefits of using a catheter valve as an alternative to free drainage, prior to undertaking a TWOC, to optimise clinical outcomes and patient experience. This article will guide nurses to increase their knowledge of catheter valves to promote person-centred informed decision-making.
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16
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Renoncourt T, Saint F, Bennis Y, Mondet L, Bloch F. Potentially Inappropriate Prescribing for Prostatic Hyperplasia in Older Persons. J Am Med Dir Assoc 2022; 23:992-997. [PMID: 34653381 DOI: 10.1016/j.jamda.2021.09.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVES In the context of improved medication management of older patients, we wished to evaluate the overprescription of potentially inappropriate drugs [α1-blockers and 5α-reductase inhibitors (5-ARI)] for benign prostate hyperplasia (BPH). These drugs are considered by geriatricians to increase the risk of falls and pharmacodynamic interactions, but these properties have not yet been proven. DESIGN This was a descriptive study of drug prescriptions in a geriatric academic center. SETTING AND PARTICIPANTS We included all patients older than 75 years who received a prescription for α1-blockers or 5-ARIs for 2 weeks in our hospital. METHODS We evaluated the prevalence of the potentially inappropriate prescription of α1-blockers and 5-ARI in older people during hospitalization using a new tool consisting of an 8-item list of explicit indicators developed using the most recent summary of product characteristics (SmPC) and latest European Association of Urology (EAU) guidelines. RESULTS A population of 117 patients (≥75 years) was included in the study. The median age was 84.5 (±6.3) years. The average time since urological medication prescription was 1.2 ± 1.6 years. According to explicit criteria, 84 patients (71.8%) received at least 1 potentially inappropriate urologic medication, 77 (91.7%) related to α1-blockers. Patients with a potentially inappropriate prescription for α1-blockers and/or 5-ARIs more frequently had urological assessments (P = .026), more frequently showed pharmacological interactions, with the risk of orthostatic hypotension (P = .005) or arrhythmia (P = .028), and experienced more falls in their history (P = .043). The misuse group was associated with an increased risk of falls, with an odds ratio of 3.22 (P = .039, 95% confidence interval 1.08-10.2). CONCLUSIONS AND IMPLICATIONS In our study, potentially inappropriate prescriptions for older individuals for BPH was close to 72% and mainly involved α1-blockers. Potentially inappropriate prescriptions for BPH were associated with a threefold higher frequency of falls.
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Affiliation(s)
- Thomas Renoncourt
- Department of Geriatric Medicine, CHU Amiens-Picardie, Amiens, France.
| | - Fabien Saint
- Department of Urology and Transplantation, CHU Amiens-Picardie, Amiens, France; EPROAD Laboratory EA 4669, Picardie Jules Verne University, Amiens, France
| | - Youssef Bennis
- Department of Pharmacology, CHU Amiens-Picardie, Amiens, France
| | - Lisa Mondet
- Department of Pharmacology, CHU Amiens-Picardie, Amiens, France
| | - Frédéric Bloch
- Department of Geriatric Medicine, CHU Amiens-Picardie, Amiens, France
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17
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Baboudjian M, Peyronnet B, Boissier R, Robert G, Cornu JN, Misrai V, Pradere B. Best nonsurgical managements of acute urinary retention: what's new? Curr Opin Urol 2022; 32:124-130. [PMID: 34954701 DOI: 10.1097/mou.0000000000000969] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To provide a comprehensive review of the nonsurgical management of acute urinary retention (AUR). RECENT FINDINGS A recent meta-analysis confirmed that α-blockers are associated with higher rates of successful trial without catheter (TWOC) compared with placebo, while combination therapies do not significantly reduce the rate of recatheterization. Compared with standard TWOC, bladder perfusion with physiological serum prior to catheter removal is a simple and cost-effective method to increase TWOC success rates (odds ratio 2.41, 95% confidence interval 1.53-3.8), and to reduce time-to-discharge (-89.68 min, 95% confidence interval -160.55, -18.88). Clean intermittent catheterization (CIC) is increasingly used for urinary retention in patients with benign prostatic hyperplasia as existing data suggest that it may decrease the risk of urinary tract infections, accelerate spontaneous voiding recovery and might be more cost-effective compared with indwelling urethral catheterization. Ongoing trials are examining whether office-placed prostate stent may be a promising solution in patients with AUR. SUMMARY The recent development of alternative approaches to traditional TWOC may lead to new therapies for treating patients with AUR. Further studies are needed as the level of evidence from published studies remains low.
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Affiliation(s)
- Michael Baboudjian
- Department of Urology, La Conception Hospital
- Department of Urology, North Hospital, Aix-Marseille University, APHM, Marseille
| | | | | | - Grégoire Robert
- Department of Urology, Bordeaux Pellegrin University Hospital, Bordeaux
| | | | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, France
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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18
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Bassily D, Wong V, Phillips JL, Fraiman M, Bauer R, Dixon CM, Wong NC. Rezūm for retention-retrospective review of water vaporization therapy in the management of urinary retention in men with benign prostatic hyperplasia. Prostate 2021; 81:1049-1054. [PMID: 34287992 DOI: 10.1002/pros.24201] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 06/03/2021] [Accepted: 07/07/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Rezūm vapor ablation is a minimally invasive treatment for benign prostatic hyperplasia (BPH) that uses injections of sterile water vapor directly into the prostate for tissue ablation. Although Rezūm is currently indicated for use in men with prostate sizes ≥30 and ≤80 ml, it is unclear how effective Rezūm is for men in urinary retention. We sought to determine whether Rezūm is effective in the treatment of catheter-dependent urinary retention secondary to BPH. METHODS A retrospective chart review was conducted on consecutive patients who presented for urinary retention and subsequently treated with Rezūm. We evaluated procedural details and examined variables pre- and post-Rezūm (at 6 months) including International Prostate Symptom Score (IPSS), IPSS quality of life (IPSS-QOL), maximum flow (Qmax ), post void residual volume (PVR), prostate specific antigen, rate of retention, and use of alpha blockers and 5-alpha reductase inhibitor (5ARI). RESULTS Of the 49 patients included in this study, median age of was 73 years, median prostate volume was 73cc (Interquartile range [IQR]: 50, 103) and a median lobe was present in 80% of patients. All patients were in urinary retention before treatment with a median PVR of 900 ml (IQR: 566, 1146). Following Rezum, IPSS (17 pre-Rezūm, 4 post-Rezūm) and IPSS-QOL (4 pre-Rezūm, 1 post-Rezūm) both improved at 6 months (p < 0.01). Qmax increased from 3 to 6 ml/s (p = 0.03) and PVR decreased from 900 to 78 ml (p < 0.01). Only 17/38 patients taking alpha-blockers and 7/15 patients on 5ARIs continued therapy at 6 months following Rezūm (p < 0.01). Of the 49 patients treated, 10 (20.4%) remained in catheter dependent urinary retention following the procedure, and 6 remained in retention at 6 months (12.2%) even after further surgical therapies for BPH (p < 0.01). CONCLUSION Rezūm is a safe and effective therapy for treating catheter dependent urinary retention in patients with BPH, including those with median lobes. As a minimally invasive therapy, it is a promising option in patient, particularly those who are not suitable for prolonged anesthesia.
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Affiliation(s)
- Daniel Bassily
- School of Medicine, New York Medical College, Valhalla, New York, USA
| | - Vincent Wong
- Department of Urology, Westchester Medical Center, Valhalla, New York, USA
| | - John L Phillips
- Department of Urology, Westchester Medical Center, Valhalla, New York, USA
| | - Mitchell Fraiman
- Department of Urology, Good Samaritan Hospital, Suffern, New York, USA
| | - Ross Bauer
- Department of Urology, Good Samaritan Hospital, Suffern, New York, USA
| | | | - Nathan C Wong
- Department of Urology, Westchester Medical Center, Valhalla, New York, USA
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19
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Adhikari B, Shrestha A, Basnet RB, Shrestha PM, Gharti BB, Shah AK. Monopolar Transurethral Resection of Prostate for Benign Prostatic Hyperplasia in Patients With and Without Preoperative Urinary Catheterization: A Prospective Comparative Study. Cureus 2021; 13:e16705. [PMID: 34466330 PMCID: PMC8397814 DOI: 10.7759/cureus.16705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 11/25/2022] Open
Abstract
Background A significant proportion of patients undergo surgery for benign prostatic hyperplasia following acute urinary retention. Studies have reported conflicting results of improvement following transurethral surgery in these patients. Objective To compare perioperative complications and postoperative voiding parameters in patients undergoing monopolar transurethral resection of prostate with and without preoperative Foley catheterization. Methods A prospective non-randomized study was conducted in patients undergoing monopolar transurethral resection of prostate for symptomatic benign prostatic hyperplasia. Patients were divided into those with Foley catheterization preoperatively (n=52), and those without catheters (n=90). Change in hemoglobin level, the resected volume of prostate, complications and the need for postoperative catheterization were compared. Postoperative symptoms score using International Prostate Symptom Score, maximum flow rate and post-void residual volume were assessed at three months follow up. Results The mean operative duration, length of stay and resected volume were higher in those patients with catheters; however, no significant differences were noted for mean hemoglobin level change and need for postoperative recatheterization. Three patients in each group required recatheterization and, all were catheter-free at one week postoperatively. Complications developed in 16.1% (n=23) with most of them being Clavien I. Patients with catheters had a lower postoperative maximum flow rate than those without it (16.90 vs 19.75 mL/sec). Patients with catheters had a significantly better postoperative quality of life and symptom score. Conclusion Monopolar transurethral resection of prostate in patients with preoperative per-urethral Foley catheter for acute urinary retention had similar postoperative voiding parameters with comparable complication rates to those without a catheter.
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Affiliation(s)
- Baikuntha Adhikari
- Urology, National Academy of Medical Sciences, Bir Hospital, Kathmandu, NPL
| | - Anil Shrestha
- Urology, National Academy of Medical Sciences, Bir Hospital, Kathmandu, NPL
| | - Robin B Basnet
- Urology, National Academy of Medical Sciences, Bir Hospital, Kathmandu, NPL
| | - Parash M Shrestha
- Urology, National Academy of Medical Sciences, Bir Hospital, Kathmandu, NPL
| | - Binod B Gharti
- Urology, National Academy of Medical Sciences, Bir Hospital, Kathmandu, NPL
| | - Arvind K Shah
- Urology, National Academy of Medical Sciences, Bir Hospital, Kathmandu, NPL
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20
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Spivak L, Morozov A, Shpikina A, Enikeev D, Rapoport L. Postoperative medical treatment of lower urinary tract symptoms after benign prostatic hyperplasia surgery. Are we underestimating the problem? Curr Opin Urol 2021; 31:451-455. [PMID: 34175875 DOI: 10.1097/mou.0000000000000912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW The aim of this study was to determine whether well timed start of medical and surgical treatment of benign prostatic obstruction (BPO) influences the treatment's effectiveness and thus the patients' overall functional outcomes and quality of life. RECENT FINDINGS Pharmacological therapy even in high-volume (>80 cm3) BPH typically begins with α-blockers sole and only subsequently are 5ARI added. Several studies showed that acute urinary retention (AUR) developed more frequently in men who suffered severe lower urinary tract symptoms (LUTS) and who did not start combination therapy immediately. Moreover, there are no strict criteria which determine the right time for performing surgery in patients with mild and moderate LUTS, especially when pharmacological therapy fails. However, sometimes, the surgery does not eliminate all the symptoms, as it deals effectively with BPO, but does not treat an overactive bladder. Also, data show that surgery should be performed as soon as possible and be more radical after the first episode of AUR. SUMMARY A combination of α-blockers and 5ARI makes for a good starting point where the treatment of high volume BPH is concerned. Ideally, surgery should be performed immediately or as soon as possible in patients with the first episode of AUR and 'anatomic' BPH tissue removal is preferable (dissection of tissue along the prostate capsule to remove its maximum volume).
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Affiliation(s)
| | | | - Anastasia Shpikina
- International School 'Medicine of the Future', Sechenov University, Moscow, Russia
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21
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Baboudjian M, Savoie PH, Long JA, Boissier R. [Acute urine retention: Epidemiology, optimization of the care pathway and alternative to permanent bladder drainage]. Prog Urol 2021; 31:967-977. [PMID: 34420877 DOI: 10.1016/j.purol.2021.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 07/10/2021] [Accepted: 07/15/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The aim of this narrative review was to report the most relevant data on the contemporary management of Acute Urine Retention (AUR). METHODS A narrative synthesis of the articles in French and English available on the Pubmed database was carried out in June 2021. We explored the registry of Surveillance sanitaire des urgences et des décès (SurSaUD®, Santé Publique France) to rise original data regarding the epidemiology of AUR in France. RESULTS AUR is a therapeutic emergency that requires a rapid bladder drainage. The average age is 71 years, 87 % are men and the stay in the emergency department is >4hours. In France, the hospitalization rate for UAR is steadily decreasing from 42% in 2014 to 32% in 2019. The introduction of an α-blocker increases the chances to get rid of the urinary catheter of 47% to 77% versus placebo. A post-emergency AUR pathway allows lowering the number of people lost with follow-up and shortening the duration of bladder drainage. The first try for catheter removal should be organized within 48-72hours of the AUR. In case of unsuccessful catheter removal, it is recommended to teach self-catheterization to the patient. The placement of a temporary prostatic stent is a promising alternative that is under evaluation. Immediate surgery is associated with increased morbidity/mortality and is not recommended. CONCLUSION AUR is a common disease. The management has been optimized in recent years to improve the prognosis and the quality of life of patients.
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Affiliation(s)
- Michael Baboudjian
- Service d'urologie et de transplantation Rénale, CHU La Conception, AP-HM, Marseille, France
| | - Pierre Henri Savoie
- Service d'urologie, hôpital d'instruction des Armées Sainte Anne, Toulon, France
| | - Jean-Alexandre Long
- Service d'urologie et de la transplantation rénale, CHU Grenoble, France; TIMC-IMAG CNRS 5525, Grenoble, France
| | - Romain Boissier
- Service d'urologie et de transplantation Rénale, CHU La Conception, AP-HM, Marseille, France.
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22
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Dressler FF, Gratzke C, Miernik A, Schoeb DS. Track and Teach: Identifying Key Movement Patterns in Endoscopic Transurethral Enucleation of the Prostate. Urol Int 2021; 105:835-845. [PMID: 33853083 DOI: 10.1159/000514596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 01/16/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE We evaluated a system for noninvasive quantitative motion tracking to recognize differences in the movement pattern of experienced surgeons and beginners. Since performing endoscopic procedures requires extensive training, and tissue damage due to disruptive movements with sudden acceleration is possible, the learning curve for beginners is of clinical relevance. Steepening this curve may improve patient outcome. MATERIALS AND METHODS We used a commercial gyroscope sensor with a wireless data link, which was attached to the resectoscope handle (RH). After recording, orientation was retrieved by application of the calculated rotation matrices to the RH vector relative to the sensor under the boundary condition of rotational movement around and quasi-constant distance to the pivot point at pelvic floor level. Data alignment, normalization, interpolation, and analysis were performed in custom software scripts. RESULTS Experienced surgeons and beginners were recorded in n = 36 and n = 14 holmium laser enucleation of the prostate (HoLEP), respectively. Prostate size, patient age, and recorded procedure duration were comparable. Mean lever angle of the individual normalized motion patterns was considerably lower (19.28 ± 0.54° [SEM]) in the advanced than in the beginners' group (24.52 ± 1.00°; p = 0.0001). Further parameters such as velocity and motion variation demonstrated additional differences between both groups. CONCLUSIONS We demonstrate the feasibility of motion tracking in HoLEP. Pronounced differences exist between different stages of surgeon experience with this procedure. The method can easily be adopted to aide young surgeons in resectoscope handling and identification of improvable motion patterns. Damage to the pelvic floor and surrounding tissue may thus be reduced.
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Affiliation(s)
- Franz F Dressler
- Department of Urology, Department of Surgery, Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Institute of Pathology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Christian Gratzke
- Department of Urology, Department of Surgery, Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Arkadiusz Miernik
- Department of Urology, Department of Surgery, Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dominik S Schoeb
- Department of Urology, Department of Surgery, Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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23
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Leng B, Zhou CG, Liu S, Xu ZW, Tian W, Shi HB. Prostatic Artery Embolization to Achieve Freedom from Catheterization in Patients with Acute Urinary Retention Caused by Benign Prostatic Hyperplasia. J Vasc Interv Radiol 2021; 32:1062-1067. [PMID: 33794374 DOI: 10.1016/j.jvir.2021.03.530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/12/2021] [Accepted: 03/20/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To determine the ability of prostatic artery embolization (PAE) to achieve freedom from catheterization in patients with acute urinary retention (AUR) caused by benign prostatic hyperplasia (BPH). MATERIALS AND METHODS This retrospective single-center study was performed between June 2014 and March 2019 in patients with lower urinary tract symptoms (LUTS) caused by BPH. PAE was performed in 154 eligible patients, of which 76 suffered from spontaneous AUR and had indwelling catheters placed and kept until the procedure, owing to clinical failure in the removal of the previous intermittent catheter. Each patient was followed for at least 12 months. The first trial without catheter was performed 3 days after PAE. Successful catheter removal within the first 30 days after PAE was considered a clinical success. The rate of patients free from catheterization, LUTS relief, prostate volume, and adverse events was recorded. RESULTS Clinical success was achieved in 70 (92.1%) patients. The rates of freedom from catheterization were 90.3% (65/72), 83.3% (60/72), and 80.6% (58/72) at 3-, 6-, and 12-months follow-up, respectively. The median elapsed time from PAE to catheter removal was 10 days. However, 18 patients needed further interventions. Symptom scores revealed a continuous improvement in urinary symptoms. The mean prostate volume showed a statistically significant decrease at 3 and 12 months compared with its baseline value. No severe adverse events occurred. CONCLUSIONS PAE can achieve freedom from catheterization in patients with AUR caused by BPH.
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Affiliation(s)
- Bin Leng
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Chun-Gao Zhou
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Sheng Liu
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Zhong-Wei Xu
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Wei Tian
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
| | - Hai-Bin Shi
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
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Khanh L, Phuong Hoai D, Thang Tai L, Huu Loc T, Fadlelmola Mohamed M, Ahmed A, Huy N. Factors associated with the success of trial without catheter in acute urinary retention due to benign prostatic hyperplasia. UROLOGICAL SCIENCE 2021. [DOI: 10.4103/uros.uros_130_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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First brachytherapy treatment of prostate cancer in Nigeria using low dose rate radioactive iodine 125. AFRICAN JOURNAL OF UROLOGY 2020. [DOI: 10.1186/s12301-020-00098-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
We report the first prostate brachytherapy in Nigeria, using low dose radioactive iodine 125 (I-125) permanent seeds implant.
Case Presentation
The low dose rate brachytherapy using I-125 implants was performed in a private clinic in the city of Benin, Edo state of Nigeria. This pilot study reports the case of the first two patients with prostate cancer. The patients were treated under spinal anesthesia using 2 ml of heavy bupibacaine which is equivalent to 10 mg of bupibacaine. Biopsy, total blood count, electrolytes, urea, creatinine, urinalysis, electrocardiogram, chest X-ray, prostate-specific antigen and bone scan were checked prior to the procedure. The first two prostate cancer patients who were in low risk category successfully received the treatment in the first day of the clinic’s operations. This paper describes the settings in which these clinical operations occurred, detailing the type of technology used, the clinical procedure and the obtained dose distribution.
Conclusions
The paper ends with discussing the overall cost of the investment and the challenges encountered as well as the perspectives of extending the brachytherapy practice to treat other cancer diseases, such as breast and genealogical cancers.
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DE Nunzio C, Voglino O, Cicione A, Tema G, Cindolo L, Bada M, Lombardo R, Nacchia A, Trucchi A, Ships L, Gacci M, Milanesi M, Cito G, Serni S, Tubaro A. Ultrasound prostate parameters as predictors of successful trial without catheter after acute urinary retention in patients ongoing medical treatment for benign prostatic hyperplasia: a prospective multicenter study. Minerva Urol Nephrol 2020; 73:625-630. [PMID: 33200904 DOI: 10.23736/s2724-6051.20.04088-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Alpha-blockers (ABs) are considered the standard treatment after initial management of acute urinary retention (AUR). However, no data are available on the predictors of a successful trial without catheter (TWOC) in patients previously on treatment with ABs and 5alpha reductase inhibitors (5ARI). The aim of our study was to investigate prostate ultrasound parameters as predictors of TWOC outcome. METHODS A consecutive series of patients, on treatment with ABs alone or in combination with 5ARI, experiencing AUR were prospectively enrolled. Clinical data (i.e., age, body mass index (BMI) and IPSS), urinary ultrasound features including hydronephrosis, prostate volume-TRUS, bladder wall thickness (BWT), intravesical prostatic protrusion more than 10mm (IPP≥10) were related to TWOC outcome performed seven days after AUR. A binary logistic regression analysis was computed to detect predictors of successful TWOC. RESULTS Overall,143 patients with a median age of 72 years (IQR 64-77) were enrolled. Seventy-mine patients (54%) with smaller prostate volume (59 [IQR 52-74] vs. 99 [IQR 74-125] mL, P=0.008) and a thinner BWT (5[IQR 4.8-5.2] vs. 5.2 [4.7-5.5] mm P=0.001) recovered voiding at TWOC. IPP≥10 was less common in patients with successful TWOC 11 (14%) vs. 33 (52%), P=0.001. On multivariate analysis, IPP<10mm (OR 6.10 [95%CI 2.61-14.20], P=0.001), lower IPSS (OR 0.95 [95% CI 0.89-0.99], P=0.045), smaller TRUS (OR 0.96 [95% CI 0.95-0.97], P=0.001), thinner BWT OR 1.23 (95%CI 0.73-0,92) P=0.001were the independent predictors of voiding recovery. CONCLUSIONS Patients receiving medical treatment for BPH and experiencing AUR still present a 54% probability of a successful TWOC. Ultrasound may help to identify patients with successful TWOC.
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Affiliation(s)
- Cosimo DE Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy -
| | - Olivia Voglino
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Antonio Cicione
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Giorgia Tema
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Luca Cindolo
- Department of Urology, S. Pio da Pietrelcina Hospital, Vasto, Chieti, Italy
| | - Maida Bada
- Department of Urology, S. Pio da Pietrelcina Hospital, Vasto, Chieti, Italy
| | - Riccardo Lombardo
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Antonio Nacchia
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Alberto Trucchi
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Luigi Ships
- Department of Urology, S. Pio da Pietrelcina Hospital, Vasto, Chieti, Italy
| | - Mauro Gacci
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Martina Milanesi
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Gianmartin Cito
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Sergio Serni
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Andrea Tubaro
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
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Gondran-Tellier B, McManus R, Sichez PC, Akiki A, Gaillet S, Toledano H, Andre M, Delaporte V, Vidal V, Karsenty G, Bastide C, Rossi D, Lechevallier E, Boissier R, Baboudjian M. Efficacy and Safety of Surgery for Benign Prostatic Obstruction in Patients with Preoperative Urinary Catheter. J Endourol 2020; 35:102-108. [PMID: 32814442 DOI: 10.1089/end.2020.0704] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Purpose: To evaluate the efficacy and safety of benign prostatic obstruction (BPO) surgery in patients with preoperative urinary catheterization. Patients and Methods: We conducted a multi-institutional retrospective study including all patients who failed a trial without catheter (TWOC) after acute urinary retention (AUR) between January 2017 and January 2019. Patients with neurogenic bladder, prostate cancer, or urethral stricture were excluded from the analysis. Patients underwent either monopolar/bipolar transurethral resection of the prostate (TURP), photoselective vaporization of the prostate (PVP), prostate artery embolization (PAE), open prostatectomy (OP), or endoscopic enucleation. The primary endpoint was 12-month urinary catheter-free survival without using benign prostatic hyperplasia medications. Results: One hundred seventy-one consecutive men (median age: 71 years; median prostate volume: 75 cm3) underwent BPO surgery, including 48 (28%) TURP, 62 (36.3%) PVP, 21 (12.3%) endoscopic enucleation, 15 (8.8%) PAE, and 25 (14.6%) OP. The median duration of preoperative urinary catheterization was 69 days (interquartile range 46-125). The 12-month urinary catheter-free survival rate was 84.8% (145/171). Satisfactory voiding returned to 121 patients (70.8%). On backward stepwise multivariable analysis, PVP (odds ratio [OR] 0.27 [0.10-0.69]; p = 0.008), PAE (OR 5.27 [1.28-27.75]; p = 0.03), endoscopic enucleation (OR 0.08 [0-0.49]; p = 0.023), OP (OR 0.10 [0.01-0.57]; p = 0.034), Charlson score (OR 1.36 [1.14-1.66]; p = 0.001), and number of preoperative TWOC failure (OR 2.53 [1.23-5.51]; p = 0.014) were significantly associated with catheter-free survival. Conclusions: In this multi-institutional retrospective study, including patients with preoperative catheterization, the overall success rate of BPO surgery was 70.8% after 1-year follow-up. Compared with TURP, enucleation methods and PVP were associated with better catheter-free survival, whereas PAE was associated with higher risk of AUR recurrence.
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Affiliation(s)
- Bastien Gondran-Tellier
- Department of Urology and Kidney Transplantation, Conception Academic Hospital, Aix-Marseille University, APHM, Marseille, France
| | - Robin McManus
- Department of Urology and Kidney Transplantation, Conception Academic Hospital, Aix-Marseille University, APHM, Marseille, France
| | - Pierre Clement Sichez
- Department of Urology and Kidney Transplantation, Conception Academic Hospital, Aix-Marseille University, APHM, Marseille, France
| | - Akram Akiki
- Department of Urology and Kidney Transplantation, Conception Academic Hospital, Aix-Marseille University, APHM, Marseille, France
| | - Sarah Gaillet
- Department of Urology and Kidney Transplantation, Conception Academic Hospital, Aix-Marseille University, APHM, Marseille, France
| | - Harry Toledano
- Department of Urology, Martigues Hospital, Martigues, France
| | - Marc Andre
- Deparment of Radiology and Medical imaging, La Timone Academic Hospital, Aix-Marseille University, APHM, Marseille, France.,European Center for Medical Imaging Research CERIMED/LIIE, Aix-Marseille University, Marseille, France
| | - Veronique Delaporte
- Department of Urology and Kidney Transplantation, Conception Academic Hospital, Aix-Marseille University, APHM, Marseille, France
| | - Vincent Vidal
- Deparment of Radiology and Medical imaging, La Timone Academic Hospital, Aix-Marseille University, APHM, Marseille, France.,European Center for Medical Imaging Research CERIMED/LIIE, Aix-Marseille University, Marseille, France
| | - Gilles Karsenty
- Department of Urology and Kidney Transplantation, Conception Academic Hospital, Aix-Marseille University, APHM, Marseille, France
| | - Cyrille Bastide
- Department of Urology, North Academic Hospital, Aix-Marseille University, APHM, Marseille, France
| | - Dominique Rossi
- Department of Urology, North Academic Hospital, Aix-Marseille University, APHM, Marseille, France
| | - Eric Lechevallier
- Department of Urology and Kidney Transplantation, Conception Academic Hospital, Aix-Marseille University, APHM, Marseille, France
| | - Romain Boissier
- Department of Urology and Kidney Transplantation, Conception Academic Hospital, Aix-Marseille University, APHM, Marseille, France
| | - Michael Baboudjian
- Department of Urology and Kidney Transplantation, Conception Academic Hospital, Aix-Marseille University, APHM, Marseille, France
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Ryan PC, Ryan ÉJ, Keenan RA, Haroon UM, Broe MP, Forde JC, Galvin D, Lennon GM, Murphy M, Quinlan DM, Mulvin DW. Admission of patients with acute urinary retention leads to a definitive management decision. Ir J Med Sci 2020; 189:999-1003. [PMID: 31858451 DOI: 10.1007/s11845-019-02164-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 12/05/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Acute urinary retention (AUR) is a common urologic emergency. However, its management is not standardized due to lack of clinical guidelines. AIMS We retrospectively reviewed the treatment of all male patients admitted to our institution with AUR over 12 months. METHODS Data was obtained from the HIPE (Hospital Inpatient Enquiry) data system, each patient's electronic discharge summary and from patient medical records. RESULTS There were 130 AUR admissions during the period. About 74 admissions were due to benign prostatic enlargement (BPE). Of these, 45.9% (n = 34) passed their trial without catheter (TWOC). The remainder (n = 40) failed their TWOC necessitating recatheterization and consideration for transurethral resection of prostate (TURP) or re-TWOC. An indwelling urinary catheter (IDC) was inserted for 27.5% (n = 11) of patients with a failed TWOC secondary to comorbidities. This group had a mean age of 78 years (range 68-96 years). Of those who failed their TWOC, 32.5% (n = 13) had a TURP on index admission. Of the remaining 16 patients with failed TWOC, 75% (n = 12) were discharged with an IDC and readmitted for an elective TURP with a median waiting time of 55 days (range 17-138 days). 18.75% (n = 3) passed a re-TWOC and thus offset the need to have any surgical intervention and 6.25% (n = 1) proceeded to a radical retropubic prostatectomy for biopsy proven prostate adenocarcinoma. CONCLUSION Admission of patients with acute urinary retention leads to a definitive management decision and reduced prolonged catheterization.
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Affiliation(s)
- Paul Christopher Ryan
- Department of Urology, St. Vincent's University Hospital (SVUH), Elm Park, Dublin 4, Ireland.
| | - Éanna J Ryan
- Department of Urology, St. Vincent's University Hospital (SVUH), Elm Park, Dublin 4, Ireland
| | - Robert A Keenan
- Department of Urology, St. Vincent's University Hospital (SVUH), Elm Park, Dublin 4, Ireland
| | - Usman M Haroon
- Department of Urology, St. Vincent's University Hospital (SVUH), Elm Park, Dublin 4, Ireland
| | - Mark P Broe
- Department of Urology, St. Vincent's University Hospital (SVUH), Elm Park, Dublin 4, Ireland
| | - James C Forde
- Department of Urology, St. Vincent's University Hospital (SVUH), Elm Park, Dublin 4, Ireland
| | - David Galvin
- Department of Urology, St. Vincent's University Hospital (SVUH), Elm Park, Dublin 4, Ireland
| | - Gerry M Lennon
- Department of Urology, St. Vincent's University Hospital (SVUH), Elm Park, Dublin 4, Ireland
| | - Michael Murphy
- Department of Urology, St. Vincent's University Hospital (SVUH), Elm Park, Dublin 4, Ireland
| | - David M Quinlan
- Department of Urology, St. Vincent's University Hospital (SVUH), Elm Park, Dublin 4, Ireland
| | - David W Mulvin
- Department of Urology, St. Vincent's University Hospital (SVUH), Elm Park, Dublin 4, Ireland
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Amaral GLGD, Costa KMDM, Lima CMFD, Domingues TAM, Barbosa DA, Belasco AGS. Quality of life and body image of patients with urinary disorders. Rev Bras Enferm 2020; 73 Suppl 1:e20190522. [PMID: 32667474 DOI: 10.1590/0034-7167-2019-0522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 01/24/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE to assess the quality of life and body image of men with difficulty urinating and indwelling urinary catheter users, integrating the socio-demographic, economic and morbidity variables. METHOD a cross-sectional analytical study with 64 male patients with urinary problems. Three questionnaires were used for data collection: one containing sociodemographic, economic and morbid data, the Medical Outcome Study 36-item short-form health survey to analyze quality of life, and the Body Dysmorphic Examination, which assesses body image. T-test, Mann-Whitney, Pearson, Spearman, Linear Regression and Stepwise were used. RESULTS quality of life and body image were compromised in both groups, affecting emotional aspects, with a high degree of body dissatisfaction and altered physical and social adversity. CONCLUSION changes in patients' quality of life and body image were observed, confirming the need for improvement in care.
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30
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Yuan B, Wang Y, Wang M, Zhang J, Yan J, Yuan K, Fu J, Wang X. Prostate artery embolization for the treatment of urinary retention caused by large (>80 mL) benign prostatic hyperplasia: Results of 21 patients. J Interv Med 2020; 3:142-145. [PMID: 34805925 PMCID: PMC8562217 DOI: 10.1016/j.jimed.2020.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Objective A large prostate size (>80 mL) of benign prostatic hyperplasia (BPH) is technically challenging to treat surgically. This study aimed to investigate the safety and efficacy of super-selective prostatic artery embolization (PAE) for the treatment of urinary retention caused by large BPH. Methods A total of 21 patients with urinary retention, indwelling urinary catheter, or suprapubic cystostomy as a consequence of giant BPH (prostate volume [PV] > 80 mL) who sought treatment between January 2013 and December 2017 were enrolled. A microcatheter (1.9-2.7 Fr) and a "two-step embolization" combining 50-μm and 100-μm polyvinyl alcohol embolization particles were used in all patients. International Prostate Symptom Score (IPSS), quality of life (QoL), PV, and prostate-specific antigen (PSA) were evaluated at 3, 6, and 12 months post-PAE. Clinical success was defined as removal of urinary catheter or suprapubic cystostomy and ability to void spontaneously. Results The clinical success rate was 95.2% (20/21). Compared with pre-procedural values, IPSS, QoL, PV, and PSA showed statistically significant differences at 3, 6, and 12 months post-PAE (P < 0.05). There were no serious complications after PAE. Conclusions PAE was safe and effective for the treatment of urinary retention caused by large BPH in patients without surgical treatment options.
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Affiliation(s)
- Bing Yuan
- Department of Interventional Radiology, Chinese PLA General Hospital, 28 Fu-xing Rd., Beijing, 100853, PR China
| | - Yan Wang
- Department of Interventional Radiology, Chinese PLA General Hospital, 28 Fu-xing Rd., Beijing, 100853, PR China
| | - MaoQiang Wang
- Department of Interventional Radiology, Chinese PLA General Hospital, 28 Fu-xing Rd., Beijing, 100853, PR China
| | - Jinlong Zhang
- Department of Interventional Radiology, Chinese PLA General Hospital, 28 Fu-xing Rd., Beijing, 100853, PR China
| | - Jieyu Yan
- Department of Interventional Radiology, Chinese PLA General Hospital, 28 Fu-xing Rd., Beijing, 100853, PR China
| | - Kai Yuan
- Department of Interventional Radiology, Chinese PLA General Hospital, 28 Fu-xing Rd., Beijing, 100853, PR China
| | - Jinxin Fu
- Department of Interventional Radiology, Chinese PLA General Hospital, 28 Fu-xing Rd., Beijing, 100853, PR China
| | - Xiuqi Wang
- Department of Interventional Radiology, Chinese PLA General Hospital, 28 Fu-xing Rd., Beijing, 100853, PR China
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Roulet M, Delbarre B, Vénara A, Hamy A, Barbieux J. Urine drainage management in colorectal surgery. J Visc Surg 2020; 157:309-316. [PMID: 32446914 DOI: 10.1016/j.jviscsurg.2020.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Enhanced recovery programs (ERP) is aimed at reducing a patient's surgical stress response, specifically by reducing the duration of catheterization. In cases of colorectal surgery, there is pronounced heterogeneity in urinary catheterization, which is largely explained by fear of acute urinary retention (AUR). OBJECTIVE The objective of the work is to report on the current literature on postoperative urinary catheterization following colorectal surgery, particularly with regard to the risk of AUR, and thereby contribute to the standardization of perioperative practices. RESULTS In colon surgery without preoperative urinary disorders, catheterization must not exceed 24h. In rectal surgery, catheter removal starting on postoperative D2 seems reasonable in the absence of AUR risk factor (RF). Male sex, past history of lower urinary tract obstruction, abdomino-perineal amputation (APA) and low rectal anastomosis are AUR risk factors that must be taken into account when deciding to withdraw the urinary catheter. While the role of a suprapubic catheter is not clearly defined, it may be of use following APA. The epidural catheter is another AUR risk factor, but it seems possible to withdraw the urinary catheter on postoperative D1, before the epidural catheter, provided that the other risk factors have been taken into full account. Lastly, up until now no satisfactorily conducted study has assessed the prophylactic value of systematic perioperative alpha-blocker treatment in colorectal surgery.
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Affiliation(s)
- M Roulet
- Service de chirurgie viscérale et endocrinienne, CHU d'Angers, 4, rue Larrey, 49100 Angers, France.
| | - B Delbarre
- Service de chirurgie urologique, CHU d'Angers, 4, rue Larrey, 49100 Angers, France
| | - A Vénara
- Service de chirurgie viscérale et endocrinienne, CHU d'Angers, 4, rue Larrey, 49100 Angers, France
| | - A Hamy
- Service de chirurgie viscérale et endocrinienne, CHU d'Angers, 4, rue Larrey, 49100 Angers, France
| | - J Barbieux
- Service de chirurgie viscérale et endocrinienne, CHU d'Angers, 4, rue Larrey, 49100 Angers, France
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Cataneo J, Córdova-Cassia C, Curran T, Alvarez D, Poylin VY. Rate of urinary retention after ileostomy takedown in men and role of routine placement of urinary catheter. Updates Surg 2020; 72:1181-1185. [PMID: 32342346 DOI: 10.1007/s13304-020-00763-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 04/10/2020] [Indexed: 11/28/2022]
Abstract
Ileostomy takedown has been proposed as one of the procedures where the placement of the catheters can be avoided, however, the rate of UR after ileostomy takedown is unknown. The aim of this study is to investigate the rate of UR after ileostomy takedown and the potential benefit of perioperative Tamsulosin. Retrospective cohort study of men undergoing ileostomy takedown after pelvic colorectal surgery between January 2009 and December 2016. A total of 100 patients were identified. The rate of UR after ileostomy takedown was high at 26%. There were no instances of urinary tract infection, however, most instances of UR were in patients who did not have catheter in surgery (96% vs. 4%, p = 0.044). Perioperative use of tamsulosin did not result in significant decrease in urinary retention. Rates of urinary retention after ileostomy takedown are high. Although not placing the catheter may be protective against urinary tract infections, patients should be counseled about the possibility of UR after ileostomy takedown.
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Affiliation(s)
- Jose Cataneo
- Department of Surgery Advocate Illinois Masonic Medical Center, University of Illinois, 836 W Wellington Ave, Chicago, IL, 60657, USA
| | - Carlos Córdova-Cassia
- Colon and Rectal Surgery Division, Beth Israel Deaconess Medical Center, Harvard Medical School Teaching Hospital, Boston, USA
| | - Thomas Curran
- Colon and Rectal Surgery, Medical University of South Carolina, 179 Ashley Ave, Charleston, SC, 29425, USA
| | - Daniel Alvarez
- Department of Radiology, University of Massachusetts Medical School, 55 Lake Ave N, Worcester, MA, 01655, USA
| | - Vitaliy Y Poylin
- Gastrointestinal Surgery Northwestern Medicine, Feinberg School of Medicine, 676 North St Clair Street, Suite 650, Chicago, IL, 60611, USA.
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Contractor R, Parikh A, Yagnik V, Vyas J, Dawka S. Comparison of the effects of tamsulosin, silodosin, and alfuzosin on catheter-free trials after acute urinary retention due to benign prostatic hyperplasia: A prospective study. UROLOGICAL SCIENCE 2020. [DOI: 10.4103/uros.uros_11_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Prostate Artery Embolization in Patients With Acute Urinary Retention. Am J Med 2019; 132:e786-e790. [PMID: 31103644 DOI: 10.1016/j.amjmed.2019.04.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/09/2019] [Accepted: 04/16/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND This prospective study assessed the efficacy of prostate artery embolization after failure of a trial without catheter in patients suffering a first episode of acute urinary retention as a result of benign prostatic hyperplasia (BPH). METHODS Patients with failure of a trial without catheter despite alpha-blocker therapy were invited to participate in this protocol. Twenty patients were included in the study, and all underwent prostate artery embolization with calibrated polyvinyl alcohol (PVA) microspheres (Bead Block, BTG Ltd., Farnham, UK). RESULTS Successful removal of the indwelling bladder catheter and spontaneous voiding was achieved in 15 of 20 (75%) patients, and the overall clinical success at 6 months after prostate embolization was 14 of 20 (70%). No patient experienced severe adverse events. CONCLUSIONS Prostate artery embolization might be a valuable treatment after a failure of a trial without catheter. Further studies are needed to better define its place in this setting.
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Huang LK, Chang YH, Shao IH, Lee TL, Hsieh ML. Clinical Outcome of Immediate Transurethral Surgery for Benign Prostate Obstruction Patients with Acute Urinary Retention: More Radical Resection Resulted in Better Voiding Function. J Clin Med 2019; 8:jcm8091278. [PMID: 31443498 PMCID: PMC6780257 DOI: 10.3390/jcm8091278] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/09/2019] [Accepted: 08/19/2019] [Indexed: 11/16/2022] Open
Abstract
Introduction: Transurethral surgery of the prostate is currently the gold standard treatment modality for patients with benign prostatic hyperplasia (BPH) with recurrent acute urinary retention. This study aimed to evaluate the outcome and predictors of patients receiving immediate surgery after acute urinary retention (AUR) episodes. Materials and Methods: From January 2016 to January 2017, we retrospectively included 714 patients who received transurethral surgery of prostate due to BPH. Among them, 158 patients received surgeries immediately after an AUR episode. General characteristics data including age, Body mass index (BMI), International prostate symptom score (IPSS score), prostate volume and Prostate-specific antigen (PSA) were reviewed. We also collected surgery-related parameters including surgical types, operation time, and specimen weight. Resection ratio was defined as (resected specimen weight)/(Transurethral ultrasound (TRUS) volume). The catheterization status on discharge, post-operative medication for BPH, and AUR within 3 months after operation were evaluated. Statistical analysis was performed with Statistical product and service solutions (SPSS). Results: The mean age of the patients was 73.5 years, with a BMI of 24 kg/m2. IPSS total score was 25 with a Voiding symptom/Storage symptom score (V/S score) of 14.6 and 10.4, respectively. A total of 74 (46.8%) patients still took medication for BPH for over 1 month after the surgeries, 28 (17.7%) patients were not catheter-free at the time of discharge, and 14 (8.9%) patients had AUR within 3 months after the surgeries. Surgical type did not impact the outcome of surgeries. In patients who received Transurethral resection of the prostate (TURP), the resection ratio is the only predictor for the catheterization status on discharge and post-operative medication for BPH within 3 months after operation. Conclusions: In patients with BPH-related AUR followed by immediate transurethral surgeries, more radical resection is significantly correlated with short-term medication-free and catheter-free status.
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Affiliation(s)
- Liang-Kang Huang
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City 33302, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City 33302, Taiwan
| | - Ying-Hsu Chang
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City 33302, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City 33302, Taiwan
| | - I-Hung Shao
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City 33302, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City 33302, Taiwan
| | - Tsung-Lin Lee
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City 33302, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City 33302, Taiwan
| | - Ming-Li Hsieh
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City 33302, Taiwan.
- College of Medicine, Chang Gung University, Taoyuan City 33302, Taiwan.
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Hirshberg B, Rheinboldt M. MDCT Imaging of Acute Bladder Pathology. Curr Probl Diagn Radiol 2019; 49:422-430. [PMID: 31142434 DOI: 10.1067/j.cpradiol.2019.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 04/01/2019] [Accepted: 05/07/2019] [Indexed: 11/22/2022]
Abstract
In this review, we will discuss and illustrate the pathophysiology, presentation, and multidetector computed tomography findings associated with emergent bladder conditions, limiting our discussion to traumatic, infectious, and obstructive etiologies. After reviewing computed tomography cystographic technique, the commonly utilized classification systems for bladder trauma will be presented with illustrative examples of associated typical and more infrequent secondary injuries and complications. Next, the pathogenesis and imaging appearance of both mechanical and neurogenic acute urinary retention will be addressed, including less common though potentially pathognomonic obstructive etiologies including urethral calculi and ectopic ureteroceles. Finally, we will review and illustrate the imaging features of both inflammatory and infectious cystitis, including hemorrhagic and emphysematous variants, as well as the potentially encountered secondary complications.
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Affiliation(s)
- Benjamin Hirshberg
- Department of Diagnostic Radiology, Emergency Radiology Division, Henry Ford Hospital, Detroit, MI
| | - Matthew Rheinboldt
- Department of Diagnostic Radiology, Emergency Radiology Division, Henry Ford Hospital, Detroit, MI.
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Guevara-Cuellar CA, Parody-Rúa E, Garcia-Perdomo HA, Arenas-Duque A. Cost-Effectiveness of Combination Therapy Versus Monotherapy in Benign Prostatic Hyperplasia: A Colombian Experience. Value Health Reg Issues 2018; 17:174-182. [PMID: 30415110 DOI: 10.1016/j.vhri.2018.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 08/23/2018] [Accepted: 09/05/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To estimate the incremental cost-effectiveness ratio of pharmacological treatment for benign prostatic hyperplasia from the payer's perspective. METHODS The cost-effectiveness of 5 mg finasteride, 0.5 mg dutasteride, 10 mg alfuzosin, 10 mg terazosin, 0.4 mg tamsulosin, 4 mg doxazosin, and the combination therapy of 5 mg finasteride and 8 mg doxazosin was evaluated using a Markov model over a 30-year period. The costs were estimated using national tariffs and were reported in US dollars. Cost and effectiveness outcomes were discounted at a rate of 5% per year. Men (aged ≥40 years) with moderate to severe lower urinary tract symptoms and uncomplicated benign prostatic hyperplasia were included in the analysis. Outcomes included costs and quality-adjusted life-years. A probabilistic sensitivity analysis was performed on important parameters with Monte-Carlo simulation. RESULTS Finasteride alone or in combination with doxazosin dominated all α-blockers. After excluding dominated alternatives, the incremental cost-utility ratio for combination therapy was $377 per quality-adjusted life-year, being a cost-effective alternative using the threshold of $15 000. Model results were robust to changes in costs, utility weights, and probabilities. Acceptability curves consistently demonstrated that the combination therapy was most likely cost-effective. CONCLUSIONS The combination of finasteride and doxazosin is cost-effective compared with dutasteride, tamsulosin, terazosin, and alfuzosin in patients with benign prostatic hyperplasia with moderate or severe symptoms who are older than 40 years.
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Affiliation(s)
- César Augusto Guevara-Cuellar
- Facultad de Ciencias de la Salud, Centro de Estudios en Protección Social y Economía de la Salud (PROESA), Universidad Icesi, Cali, Colombia.
| | - Elizabeth Parody-Rúa
- Facultad de Ciencias Naturales, Centro de Estudios en Protección Social y Economía de la Salud (PROESA), Universidad Icesi, Cali, Colombia
| | | | - Andrea Arenas-Duque
- Centro de Estudios en Protección Social y Economía de la Salud (PROESA), Universidad Icesi, Cali, Colombia
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Gas J, Liaigre-Ramos A, Caubet-Kamar N, Beauval JB, Lesourd M, Prudhomme T, Huyghe E, Soulié M, Charpentier S, Gamé X. Evaluation of the impact of a clinical pathway on the progression of acute urinary retention. Neurourol Urodyn 2018; 38:387-392. [PMID: 30418678 DOI: 10.1002/nau.23873] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 07/02/2018] [Indexed: 11/10/2022]
Abstract
AIMS The management of acute urinary retention (AUR) revolves around trial without catheter (TWOC) after prescription of an alpha-blocker. This study evaluates the implementation of a clinical pathway for AUR. METHODS Specific clinical pathways for AUR was established between the Emergency Department and the Department of Urology in order to reduce the duration of bladder drainage that included standard prescriptions, an information sheet, and a note to be faxed to scheduling nurses to organize the trial without catheter (TWOC). The main endpoint was the reduction in the time between the AUR episode and TWOC, without decreasing urination. RESULTS Between April 2015 and December 2016, 248 patients were treated in the Emergency Department, and externally, for AUR. One hundred and seventy patients were enrolled in the pathway group and 78 in the control group. The mean duration of urinary catheterization decreased by 5.5 days as did the number of patients lost to follow-up (32% vs 76%), without decreasing the successful voiding (46% vs 36%). The duration of the urinary catheterization was not related to the chance of successful voiding regardless of the urine volume and a drainage time of over 10 days significantly reduced the chance of success (68%, n = 26 versus 42%, n = 76; P = 0.0038). CONCLUSION The implementation of a clinical pathway for AUR reduced the number of patients lost to follow-up and the catheterization duration, thus optimizing the management of these patients.
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Affiliation(s)
- Jérôme Gas
- Department of Urology, Kidney Transplant and Andrology, Toulouse University Hospital, Toulouse, France
| | - Aline Liaigre-Ramos
- Urgent Care Admissions Department, Toulouse University Hospital, Toulouse, France
| | - Natacha Caubet-Kamar
- Urgent Care Admissions Department, Toulouse University Hospital, Toulouse, France
| | - Jean Baptiste Beauval
- Department of Urology, Kidney Transplant and Andrology, Toulouse University Hospital, Toulouse, France
| | - Marine Lesourd
- Department of Urology, Kidney Transplant and Andrology, Toulouse University Hospital, Toulouse, France
| | - Thomas Prudhomme
- Department of Urology, Kidney Transplant and Andrology, Toulouse University Hospital, Toulouse, France
| | - Eric Huyghe
- Department of Urology, Kidney Transplant and Andrology, Toulouse University Hospital, Toulouse, France
| | - Michel Soulié
- Department of Urology, Kidney Transplant and Andrology, Toulouse University Hospital, Toulouse, France
| | - Sandrine Charpentier
- Urgent Care Admissions Department, Toulouse University Hospital, Toulouse, France
| | - Xavier Gamé
- Department of Urology, Kidney Transplant and Andrology, Toulouse University Hospital, Toulouse, France
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Vella M, Abrate A, Costanzo A, D'Amato F, Tarantino ML, Simonato A. Predictive variables of spontaneous micturition recovery after acute urinary retention in men with benign prostatic enlargement: An observational prospective study. Low Urin Tract Symptoms 2018; 11:104-108. [PMID: 30182536 DOI: 10.1111/luts.12241] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 06/19/2018] [Accepted: 07/25/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Acute urinary retention (AUR) is the sudden and painful inability to urinate spontaneously. AUR is one of the most significant complications of benign prostatic enlargement. The management of AUR is based on transurethral catheterization. Subsequent therapy is uncertain, but AUR seems to benefit from the use of alpha-blockers. The aim of this study was to evaluate the variables that could predict which patients would recover spontaneous micturition after trial without catheter. METHODS The present prospective observational study included men with AUR in an Italian tertiary care institute in 2016. Patients were catheterized and treated orally with fluoroquinolones, alpha-blockers, and Serenoa repens extracts. Preoperative variables as age, C-reactive protein (CRP), previous prostate-specific antigen values, urinary retention volume, prostate volume, and scores on a modified International Prostate Symptom Score questionnaire (IPSS-4), were investigated in relation to spontaneous micturition recovery. RESULTS Mean (±SD) age was 68.4 ± 7.1 years. Spontaneous and valid micturition recovery was observed in 11 patients (29.7%), whereas 26 (70.3%) needed to be catheterized again. The IPSS-4 score was significantly lower (9 vs 17; P < .001) and CRP values were significantly higher (43.00 vs 1.00 mg/dL; P < .001) in patients who recovered spontaneous micturition. The IPSS-4 scores and CRP showed an area under the curve of 0.85 and 0.87, respectively. for the prediction of spontaneous and valid micturition recovery. CONCLUSION CRP and IPSS-4 could be useful tools to predict spontaneous micturition recovery after catheterization associated with medical therapy for AUR.
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Affiliation(s)
- Marco Vella
- Department of Surgical, Oncological and Stomatological Sciences, Section of Urology, University of Palermo, Palermo, Italy
| | - Alberto Abrate
- Department of Surgical, Oncological and Stomatological Sciences, Section of Urology, University of Palermo, Palermo, Italy
| | - Angela Costanzo
- Department of Surgical, Oncological and Stomatological Sciences, Section of Urology, University of Palermo, Palermo, Italy
| | - Francesco D'Amato
- Department of Surgical, Oncological and Stomatological Sciences, Section of Urology, University of Palermo, Palermo, Italy
| | - Maria L Tarantino
- Department of Surgical, Oncological and Stomatological Sciences, Section of Urology, University of Palermo, Palermo, Italy
| | - Alchiede Simonato
- Department of Surgical, Oncological and Stomatological Sciences, Section of Urology, University of Palermo, Palermo, Italy
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Helo S, Holland B, McVary KT. Convective Radiofrequency Water Vapor Thermal Therapy with Rezūm System. Curr Urol Rep 2018; 18:78. [PMID: 28780635 DOI: 10.1007/s11934-017-0728-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) are amongst the most commonly treated conditions by urologists. Minimally invasive therapies for the treatment of BPH/LUTS have garnered increased interest as new technology has emerged, improving durability, efficacy, and safety. This paper reviews the most recent literature regarding water vapor therapy, a convective thermal therapy that ablates prostatic tissue. RECENT FINDINGS The current literature includes a pilot study of 65 men and a randomized controlled trial (RCT) of 197 men investigating the efficacy and safety profile of water vapor therapy up to 2 years. Subjects treated with water vapor therapy demonstrated a 51% reduction in IPSS from baseline, sustained at 24 months (p < 0.0001). Durable improvements in max flow rate (Qmax) and quality of life (QoL) were also achieved, while no changes in sexual function were observed. Reporting of adverse events (AEs) reveals predominantly Clavien grade I complications that were self-limited. The clinical efficacy and safety of water vapor therapy are durable to 24 months making it an attractive alternative for patients seeking a minimally invasive treatment for LUTS due to BPH.
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Affiliation(s)
- Sevann Helo
- Division of Urology, Southern Illinois University School of Medicine, St. John's Pavilion, 301 North Eighth St., P.O. Box 19665, Springfield, IL, 62794-9665, USA
| | - Bradley Holland
- Division of Urology, Southern Illinois University School of Medicine, St. John's Pavilion, 301 North Eighth St., P.O. Box 19665, Springfield, IL, 62794-9665, USA
| | - Kevin T McVary
- Division of Urology, Southern Illinois University School of Medicine, St. John's Pavilion, 301 North Eighth St., P.O. Box 19665, Springfield, IL, 62794-9665, USA.
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Brouwer TA, van den Boogaard C, van Roon EN, Kalkman CJ, Veeger N. Non-invasive bladder volume measurement for the prevention of postoperative urinary retention: validation of two ultrasound devices in a clinical setting. J Clin Monit Comput 2018. [PMID: 29516310 PMCID: PMC6209055 DOI: 10.1007/s10877-018-0123-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Ultrasound scanning of bladder volume is used for prevention of postoperative urinary retention (POUR). Accurate assessment of bladder volume is needed to allow clinical decision-making regarding the need for postoperative catheterization. Two commonly used ultrasound devices, the BladderScan® BVI 9400 and the newly released Prime® (Verathon Medical®, Bothell, WA, USA), with or without the ‘pre-scan’ option, have not been validated in clinical practice. The aim of this study was to assess the performance of these devices in daily clinical practice. Between June and September 2016 a prospective observational study was conducted in 318 surgical patients (18 years or older) who needed a urinary catheter perioperatively for clinical reasons. For acceptable performance, we required that the volume as estimated by the BladderScan® differs by no more than 5% from the actual urine volume after catheterization. The Schuirmann’s two one-sided test was performed to assess equivalence between the BladderScan® estimate and catheterization. The BVI 9400® overestimated the actual bladder volume by + 17.5% (95% CI + 8.8 to + 26.3%). The Prime® without pre-scan underestimated by − 4.1% (95% CI − 8.8 to + 0.5%) and the Prime® with pre-scan underestimated by − 6.3% (95% CI − 11.6 to − 1.1%). This study shows that while both ultrasound devices were able to approximate current bladder volume, both BVI 9400® and Prime®—with and without pre-scan—were not able to measure the actual bladder volume within our predefined limit of ± 5%. Using the pre-scan feature of the Prime® did not further improve accuracy.
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Affiliation(s)
- Tammo A. Brouwer
- Department of Anaesthesiology, Medical Center Leeuwarden, Henri Dunantweg 2, PO Box 888, 8901 BR Leeuwarden, The Netherlands
| | - Charina van den Boogaard
- Institute for Science, Medical Center Leeuwarden, Henri Dunantweg 2, PO Box 888, 8901 BR Leeuwarden, The Netherlands
| | - Eric N. van Roon
- Department of Pharmacotherapy, Epidemiology and Economics, University of Groningen, Groningen, The Netherlands
- Department of Clinical Pharmacy and Pharmacology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Cor J. Kalkman
- Division of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nic Veeger
- Clinical Epidemiologist, Department of Epidemiology, Medical Center Leeuwarden, Henri Dunantweg 2, PO Box 888, 8901 BR Leeuwarden, The Netherlands
- Department of Epidemiology, University Medical Center, Groningen, The Netherlands
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Abstract
Urologic emergencies can involve the kidneys, ureters, bladder, urethra, penis, scrotum, or testicles. History and physical examination are essential to diagnosis, whereas imaging is increasingly used to confirm diagnoses. Acute urinary retention should be relieved with Foley placement. Penile emergencies include paraphimosis, which can be treated by foreskin reduction, whereas penile fracture and priapism require urologic intervention. Fournier gangrene and testicular torsion are scrotal emergencies requiring emergent surgery. Nephrolithiasis, although painful, is not an emergency unless there is concern for concomitant urinary tract infection, both ureters are obstructed by stones, or there is an obstructing stone in a solitary kidney.
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Affiliation(s)
- Adarsh S Manjunath
- Department of Urology, Northwestern University Feinberg School of Medicine, 303 East Chicago Avenue 16-703, Chicago, IL 60611, USA
| | - Matthias D Hofer
- Department of Urology, Northwestern University Feinberg School of Medicine, 303 East Chicago Avenue 16-703, Chicago, IL 60611, USA.
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Gas J, Liaigre-Ramos A, Beauval JB, Roumiguié M, Tostivint V, Patard PM, Huyghe E, Soulié M, Charpentier S, Gamé X. [Epidemiology of emergency consultations for acute urine retention]. Prog Urol 2018; 28:107-113. [PMID: 29337127 DOI: 10.1016/j.purol.2017.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 11/16/2017] [Accepted: 12/01/2017] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Acute urinary retention (AUR) is a common reason for emergency consultation. It may be spontaneous or precipitated and affects both men and women. The purpose of this study was to determine the profile of men visiting emergency departments for an AUR. MATERIEL AND METHODS A retrospective monocentric study including all men who consulted the emergency department between January 2014 and December 2016 for AUR was conducted. RESULTS In 3 years, 731 patients were admitted for AUR (611 men and 120 women). The mean age was 71.6±14 years with a mean retention volume of 948±668mL drained for 96% of patients (n=584) through a bladder catheter and 4% (n=27) with a suprapubic catheter. Most patients had an urological (66%, n=104) or neurologic (40%, n=242) history and 23% (n=136) already had an episode of AUR. In 28% of cases (n=173), the globe was not painful. A majority of AUR were spontaneous, 53% (n=326) versus 46% (n=279) who were precipitated, secondary to a recent surgical procedure (<1 month) (15%, n=89), hematuria (9%, n=54), or male urinary tract infections (7%, n=42). Patients were treated externally in 71% (n=436), 25% (n=153) were hospitalized with significantly more comorbidities. CONCLUSION Men consulting emergency for AUR are 72 years old, with a globe volume of 942mL. Thirty-three percent have a history of BPH, with a prostate treatment like alpha-blockers type. Almost all patients were treated with a bladder catheter and the majority was treated externally. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- J Gas
- Département d'urologie, transplantation rénale et andrologie, CHU de Toulouse, 31059 Toulouse, France.
| | - A Liaigre-Ramos
- Service d'accueil des urgences, CHU de Toulouse, 31059 Toulouse, France
| | - J B Beauval
- Département d'urologie, transplantation rénale et andrologie, CHU de Toulouse, 31059 Toulouse, France
| | - M Roumiguié
- Département d'urologie, transplantation rénale et andrologie, CHU de Toulouse, 31059 Toulouse, France
| | - V Tostivint
- Département d'urologie, transplantation rénale et andrologie, CHU de Toulouse, 31059 Toulouse, France
| | - P-M Patard
- Département d'urologie, transplantation rénale et andrologie, CHU de Toulouse, 31059 Toulouse, France
| | - E Huyghe
- Département d'urologie, transplantation rénale et andrologie, CHU de Toulouse, 31059 Toulouse, France
| | - M Soulié
- Département d'urologie, transplantation rénale et andrologie, CHU de Toulouse, 31059 Toulouse, France
| | - S Charpentier
- Service d'accueil des urgences, CHU de Toulouse, 31059 Toulouse, France
| | - X Gamé
- Département d'urologie, transplantation rénale et andrologie, CHU de Toulouse, 31059 Toulouse, France
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Salem Mohamed S, El Ebiary MES, Badr M. Early versus late trail of catheter removal in patients with urinary retention secondary to benign prostatic hyperplasia under tamsulosin treatment. UROLOGICAL SCIENCE 2018. [DOI: 10.4103/uros.uros_12_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Bhatia S, Sinha VK, Kava BR, Gomez C, Harward S, Punnen S, Kably I, Miller J, Parekh DJ. Efficacy of Prostatic Artery Embolization for Catheter-Dependent Patients with Large Prostate Sizes and High Comorbidity Scores. J Vasc Interv Radiol 2017; 29:78-84.e1. [PMID: 29150394 DOI: 10.1016/j.jvir.2017.08.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 08/29/2017] [Accepted: 08/29/2017] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To evaluate efficacy and safety of prostate artery embolization (PAE) in urinary catheter-dependent patients with large prostate volumes and high comorbidity scores. MATERIALS AND METHODS A retrospective single-center review was conducted of 30 patients with urinary retention at time of PAE from November 2014 through February 2017. Mean (range) age was 73.1 years (48-94 y), age-adjusted Charlson comorbidity index was 4.5 (0-10), duration of urinary retention was 63.4 days (2-224 d), International Prostate Symptom Score quality-of-life (IPSS-QOL) was 5.3 (3-6), and prostate volume was 167.3 cm3 (55-557 cm3). These parameters were collected at 3, 6, and 12 months after PAE. Trials of voiding were performed approximately 2 weeks after PAE and, if failed, every 2 weeks thereafter. Adverse events were graded using the Clavien-Dindo classification. RESULTS At a mean (range) of 18.2 days (1-72 d), 26 (86.7%) patients were no longer reliant on catheters. Follow-up was obtained in all patients eligible at 3 and 6 months and 17 of 20 (85.0%) patients eligible at 1 year. Mean (range) IPSS-QOL improved significantly to 1.2 (0-5), 0.7 (0-4), and 0.6 (0-4) at 3, 6, and 12 months (all P < .001). Mean (range) prostate volume decreased significantly to 115.9 cm3 (27-248 cm3) at 3 months (P < .001). Two patients experienced grade II urosepsis complications, which were successfully treated with intravenous antibiotics. All other complications were self-limited grade I complications. CONCLUSIONS PAE represents a safe and effective option for management of patients with urinary retention, especially patients with large prostates who are not ideal surgical candidates.
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Affiliation(s)
- Shivank Bhatia
- Department of Vascular and Interventional Radiology, Jackson Memorial Hospital, University of Miami Miller School of Medicine, 1150 NW 14th Street, Suite 511, Miami, FL 33136; Miami VA Healthcare System, Miami, Florida.
| | - Vishal K Sinha
- University of Miami Miller School of Medicine, 1150 NW 14th Street, Suite 511, Miami, FL 33136
| | - Bruce R Kava
- Department of Urology, Jackson Memorial Hospital, University of Miami Miller School of Medicine, 1150 NW 14th Street, Suite 511, Miami, FL 33136; Miami VA Healthcare System, Miami, Florida
| | - Christopher Gomez
- Department of Urology, Jackson Memorial Hospital, University of Miami Miller School of Medicine, 1150 NW 14th Street, Suite 511, Miami, FL 33136
| | - Sardis Harward
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
| | - Sanoj Punnen
- Department of Urology, Jackson Memorial Hospital, University of Miami Miller School of Medicine, 1150 NW 14th Street, Suite 511, Miami, FL 33136
| | - Issam Kably
- Department of Vascular and Interventional Radiology, Jackson Memorial Hospital, University of Miami Miller School of Medicine, 1150 NW 14th Street, Suite 511, Miami, FL 33136
| | - Jeffrey Miller
- Department of Urology, Boca Raton Regional Hospital, Boca Raton, Florida
| | - Dipen J Parekh
- Department of Urology, Jackson Memorial Hospital, University of Miami Miller School of Medicine, 1150 NW 14th Street, Suite 511, Miami, FL 33136
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Efficacy, Safety, and Durability of 532 nm Laser Photovaporization of the Prostate with GreenLight 180 W XPS in Men with Acute Urinary Retention. J Endourol 2017; 31:1189-1194. [DOI: 10.1089/end.2017.0488] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Homma Y, Gotoh M, Kawauchi A, Kojima Y, Masumori N, Nagai A, Saitoh T, Sakai H, Takahashi S, Ukimura O, Yamanishi T, Yokoyama O, Yoshida M, Maeda K. Clinical guidelines for male lower urinary tract symptoms and benign prostatic hyperplasia. Int J Urol 2017; 24:716-729. [DOI: 10.1111/iju.13401] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 05/23/2017] [Indexed: 12/29/2022]
Affiliation(s)
- Yukio Homma
- Department of Urology; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Momokazu Gotoh
- Department of Urology; Nagoya University Graduate School of Medicine; Nagoya Japan
| | | | - Yoshiyuki Kojima
- Department of Urology; Fukushima Prefectural University of Medicine; Fukushima Japan
| | - Naoya Masumori
- Department of Urology; Sapporo Medical University School of Medicine; Sapporo Japan
| | - Atsushi Nagai
- Department of Urology; Kawasaki Medical School; Kurashiki Japan
| | | | - Hideki Sakai
- Department of Urology; Nagasaki University; Nagasaki Japan
| | | | - Osamu Ukimura
- Department of Urology; Kyoto Prefectural University of Medicine; Kyoto Japan
| | | | | | - Masaki Yoshida
- Department of Urology; National Center of Geriatrics and Gerontology; Obu Japan
| | - Kenji Maeda
- Department of Urology; Maeda Clinic of Internal Medicine; Ageo Japan
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Lee KS, Koo KC, Lee SH, Cho KS, Hong CH, Chung BH. Effect of Climatic Parameters on Acute Urinary Retention Incidence. Low Urin Tract Symptoms 2017; 10:297-302. [PMID: 28707361 DOI: 10.1111/luts.12184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 03/15/2017] [Accepted: 04/03/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We investigated the effect of daily climatic parameters on spontaneous acute urinary retention (sAUR) and evaluated the risk factors for refractory/recurrent AUR. METHODS A total of 4194 patients older than 40 years were diagnosed with AUR in the emergency department at Gangnam Severance Hospital, Seoul, from January 2007 to May 2016. To evaluate climatic parameters at sAUR onset, we included individuals living in the area around the hospital. We excluded patients with fever, who did not return to the hospital after the AUR episode or with AUR occurring within 2 weeks following admission for surgery or chemotherapy. RESULTS Among 818 patients living in the two districts around the hospital, winter and October had the highest seasonal and monthly rates of sAUR development, respectively, and sAUR incidence increased with age. Daily temperature range and mean wind speed were significant risk factors for sAUR development. Several daily climatic parameters had seasonal effects on sAUR incidence. Over a mean follow-up of 0.98 years, 122 patients (14.9%) developed refractory/recurrent AUR. Transitional zone index (TZI; HR = 1.03; P = 0.002) and prostate-specific antigen (PSA) at the time of sAUR (HR = 1.01; P = 0.030) were significant predictors of refractory/recurrent AUR. Benign prostate hyperplasia medication and transurethral prostatectomy after sAUR were not risk factors for refractory/recurrent AUR. CONCLUSIONS Cold temperature provoked sAUR in patients with higher age and International Prostate Symptom Score. Patients with higher TZI and PSA level at the time of sAUR had a greater risk of developing refractory/recurrent AUR.
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Affiliation(s)
- Kwang Suk Lee
- Department of Urology, Yonsei University College of Medicine, Seoul, Korea
| | - Kyo Chul Koo
- Department of Urology, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Hwan Lee
- Department of Urology, Yonsei University College of Medicine, Seoul, Korea
| | - Kang Su Cho
- Department of Urology, Yonsei University College of Medicine, Seoul, Korea
| | - Chang-Hee Hong
- Department of Urology, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Ha Chung
- Department of Urology, Yonsei University College of Medicine, Seoul, Korea
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Bansal A, Arora A. Predictors of successful trial without catheter following acute urinary retention in benign prostatic enlargement: A single centre, multivariate analysis. Neurourol Urodyn 2017; 36:1757-1762. [PMID: 28101889 DOI: 10.1002/nau.23194] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 11/21/2016] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To evaluate the parameters which predict the success or failure of trial without catheter (TWOC) for acute urine retention (AUR). MATERIALS AND METHODS Medical records of 2 188 patients presenting with first episode of AUR were analyzed. All patients underwent catheterization and were started on α-blocker followed by TWOC. Age, baseline American urological association (AUA) score, prostate volume (PV), residual volume of urine (RV) and intravesical prostatic protrusion (IPP), prostate specific antigen (PSA) were recorded. RESULTS TWOC was successful in 737 patients (33.7%) and failed in 1 451 patients (66.3%). Patients with successful TWOC had lower mean age, PV, IPP, RV, AUA score, and PSA than those with failed TWOC. On multivariate analysis, the significant independent predictors were IPP, age, AUA score, PV, and RV at odds ratios of 3.11, 1.84, 1.78, 1.53, and 1.23, respectively. From ROC curve, IPP had cut off value of 9 mm and detected success of TWOC with sensitivity (S) of 91% and failure with specificity (s) of 90%. Similarly, cut off value of 64 years for age (S:86%, s:87%), 20 for AUA symptom score (S:83%, s:81%), 56 cc for PV (S:80%, s:74%) and 750 mL for RV (S:71%, s:68%) were obtained. CONCLUSION Age, baseline AUA score, IPP, PV, and RV independently predict the outcome of TWOC. Patients with IPP > 9 mm, age > 65 years, baseline AUA score > 20, PV > 56 cc, or RV > 750 mL have less probability of successful TWOC in AUR and can be considered for immediate surgery following an episode of AUR.
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Affiliation(s)
| | - Aditi Arora
- Janak Surgicare Centre, Patiala, Punjab, India
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Abstract
Urinary retention is an important and potentially avoidable postoperative complication. Identifying risk factors for retention is important given expedient bladder decompression is important for long-term outcomes. Age, benign prostatic hyperplasia, and lower urinary tract symptoms are patient factors that predispose to retention. Surgery-related factors include operative time, intravenous fluid administration, type of anesthesia, and procedure type. The mainstay for treatment in the acute setting is Foley catheter placement. Starting alpha-blockers in men is also indicated as they increase voiding trial success. Long-term solutions for chronic retention include a variety of surgeries, with transurethral prostatectomy as the gold standard.
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Affiliation(s)
- Urszula Kowalik
- University of Vermont Medical Center, 111 Colchester Avenue, Mailstop 222WP2, Burlington, VT 05401, USA
| | - Mark K Plante
- Division of Urology, Department of Surgery, University of Vermont Medical Center, University of Vermont College of Medicine, 111 Colchester Avenue, Mailstop 320FL4, Burlington, VT 05401, USA.
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