Factors Predicting Outcome of Trial without Catheter in Patients with Acute Urinary Retention Secondary to Prostatic Enlargement

Abstract

Introduction: Acute Urinary Retention (AUR) is an important feature of progression of Benign Prostatic Hyperplasia (BPH). The management of AUR is immediate urethral catheterisation followed by Trial without Catheter (TWOC). Aim: The aim of this study was to evaluate the factors predicting outcome of TWOC in patients with AUR due to BPH. Materials and Methods: Ninety patients with spontaneous AUR secondary to BPH were selected for the study. Various factors e.g., age, duration of Lower Urinary Tract Symptoms (LUTS), drained urinary volume, Digital Rectal Examination (DRE) prostate size, Ultrasonography (USG) prostate volume, thickened bladder wall, Intravesical Prostatic Protrusion (IPP) grade were recorded. Tamsulosin was administered for three days before trial. The TWOC was considered successful if patient voided within six hours with Qmax >5 mL/second and Post Void Residual (PVR) urine <200 mL. Logistic regression analysis was performed to identify predictors and Receiver Operating Curve (ROC) was constructed. Results: It was observed that among 90 patients with AUR due to BPH, 56.7% had successful TWOC and rest failed the attempt. Cases in failure group had thicker bladder wall compared to those in successful group (97.4% v/s 80.4%, p=0.020). Grade III IPP was associated with higher percentage (72.7%) of failure of TWOC than Grade I (10%) and II (52.6%). A cut-off value of two and a half months for duration of LUTS (AUROC=0.625), 775 mL for drained urinary volume (AUROC=0.726) and 49.5 mL for prostate volume (AUROC=0.588) gave modest sensitivity for trial to fail. Conclusion: Our data concludes that drained urinary volume and IPP are significant predictors of outcome of TWOC in patients with AUR due to BPH.

Keywords

• benign prostatic hyperplasia
• prostatic protrusion
• urinary bladder