Predictors of successful trial without catheter following acute urinary retention in benign prostatic enlargement: A single centre, multivariate analysis

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.

Predictors of Successful Trial without Catheter for Postoperative Urinary Retention Following Non-Urological Surgery

Purpose

To investigate the success rate of trial without catheter (TWOC) for postoperative urinary retention (POUR) after non-urological surgery and to determine predictors of successful TWOC.

Methods

A total of 104 patients who underwent non-urological surgery and were referred to the department of urology for POUR were included in this retrospective study. All eligible patients underwent indwelling catheterization as an initial treatment and then TWOC was performed 3 to 7 days later. POUR was defined as micturition difficulty with greater than 400 mL of postvoid residual (PVR) urine volume measured by catheterization after non-urological surgery. Successful TWOC was defined as voiding with less than 100 mL of PVR urine volume. Predictive factors were identified by multivariate regression analysis. All definitions corresponded to recommendations of the International Continence Society.

Results

The mean age of the patients was 65.2 (range, 23 to 92) years. There were 45 male and 59 female patients. Intraoperative indwelling catheterization was performed in 69 (66.3%) patients. Mean duration of indwelling catheterization for POUR was 5.0 (range, 3.0 to 7.0) days and 83 (79.8%) patients received medication with an alpha-blocker. A successful TWOC was observed in 70 (67.4%) patients. The mean age of the patients with failure of TWOC was significantly higher than that of the patients with successful TWOC. The percentages of female patients, spinal surgery, and prone position during surgery in patients with unsuccessful TWOC were higher than in those with successful TWOC. In the multivariate logistic regression analysis, age and location of surgery (spine vs. non-spine) were the independent predictors of successful TWOC for POUR.

Conclusions

Our data suggest that older age and spinal surgery may be important risk factors for failure of TWOC for POUR after non-urological surgery. Thus, adequate prevention measures may be necessary for POUR after non-urological surgery, especially in patients with these risk factors.