Prostate size influences the outcome after presenting with acute urinary retention.
OBJECTIVE
To evaluate the long-term outcome in an open follow-up of a cohort of patients who had had a successful trial without catheter (TWOC) after an episode of acute urinary retention (AUR), as it is now widely accepted that giving an alpha-blocker, e.g. alfuzosin, increases the success rate of TWOC.


METHODS
In this prospective trial, 81 patients with a first episode of AUR related to benign prostatic obstruction received either sustained-release alfuzosin (40) 5 mg twice daily or placebo (41) for 48 h. The catheter was removed after 24 h of treatment and the patient's ability to void assessed. Those who voided successfully entered an open follow-up, the defined endpoints of which were the date of recurrent AUR, date of bladder outlet surgery, date of last follow-up or death, and factors that influenced the long-term outcome after a successful TWOC were examined.


RESULTS
Of the 34 patients who had a successful TWOC (22 on alfuzosin, 12 placebo, P= 0.03), 21 continued on an alpha-blocker at the discretion of their urologist. In all, 26 had a further episode of AUR or surgery during the 6-year follow-up. The mean (median, range) time to the second episode of AUR in the 20 (59%) patients affected was 1.4 (0.6, 0-5.95) years. Nineteen (56%) men had bladder outlet surgery, 13 after a second episode of AUR. The mean time to operation after the first AUR was 1.85 (1.1, 0.04-5.4) years. The remaining eight (24%) patients remained free of further AUR and surgery. The size of the prostate assessed on a digital rectal examination by the admitting urologist was the only factor with a significant effect on the long-term outcome. A postvoid residual of > 50 mL was associated with a greater likelihood of recurrent AUR or surgery, but this was not statistically significant.


CONCLUSIONS
This study provides further evidence of the importance of prostate size as a prognostic factor in determining the outcome in patients with prostatic obstruction. Whilst most men presenting with AUR will eventually have prostatic surgery, a significant minority will not. An assessment of risk factors such as prostate size may identify those who require urgent intervention after a successful TWOC. The role of continued medical therapy with alpha-blockers and/or 5alpha-reductase inhibitors after a successful TWOC merits further investigation.
Department of Urology, Western General Hospital, Edinburgh, Scotland, UK. alan.mcneill@luht.scot.nhs.uk
Alan S
AS
McNeill
Syed
S
Rizvi
Derek J
DJ
Byrne
D000208:Acute Disease; D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use; D000368:Aged; D015331:Cohort Studies; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology*; D011470:Prostatic Hyperplasia / Q000188:drug therapy / Q000473:pathology*; D011799:Quinazolines / Q000627:therapeutic use; D017211:Treatment Failure; D016055:Urinary Retention / Q000209:etiology* / Q000473:pathology
D000317:Adrenergic alpha-Antagonists; D011799:Quinazolines; C047638:alfuzosin