Failure Rate of Trial Without Catheter after Alpha Adrenergic Blockers in Patients with Benign Prostatic Hyperplasia in Acute Urinary Retention

Failure Rate of Trial Without Catheter after Alpha Adrenergic Blockers in Patients with Benign Prostatic Hyperplasia in Acute Urinary Retention
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Title:Failure Rate of Trial Without Catheter after Alpha Adrenergic Blockers in Patients with Benign Prostatic Hyperplasia in Acute Urinary Retention
Author/Abstract:
Failure Rate of Trial Without Catheter after Alpha Adrenergic  Blockers in Patients with Benign Prostatic Hyperplasia in Acute Urinary Retention

Roy DC. Lascano, MD1; Michael S. Sagun, MD1; Brian S. Buckley, PhD2 and Marie Carmela M. Lapitan, MD, FPUA1,2,3

1Division of Urology, Department of Surgery, University of the Philippines-Philippine General Hospital
2Department of Surgery, College of Medicine, University of the Philippines Manila
3National Institutes of Health, University of the Philippines Manila

Objective: This study aimed to determine the failure rate of trial without catheter (TWOC) after intake of alpha blockers and the factors associated with failed TWOC.

Materials and Methods: This is a prospective cohort study of 100 Filipino males presenting with acute urinary retention associated with benign prostatic hyperplasia and underwent TWOC after alphaadrenergic blocker intake of 7 days, and 2 and 4 weeks thereafter. The following were subjected to univariate and multivariate analyses to determine their association with the outcome of the TWOC: age, volume drained upon catheterization, comorbidities, previous intake of alpha blockers, previous intake of 5-alpha-reductase inhibitors, IPSS at the time of urinary retention, prostate size and the presence of intravesical prostatic protrusion, Factors found significantly related to the outcome of the TWOC were subjected to regression analyses.

Results: Overall failure rate at 5 weeks on alpha adrenergic blockers post-retention was 67%. On univariate analysis, higher IPSS score was significantly associated with a higher risk of failure. Both the total obstructive scores and the total irritative scores showed significant association with the riskof TWOC failure. On multivariate analysis, a significant association was found between the composite obstructive IPSS score and TWOC outcome. Among those who initially voided at 1 week but eventually went into retention in the subsequent 4 weeks, only age was found to be related to the TWOC outcome. Older men were more likely to subsequently develop recurrence of the retention within 4 weeks of initial successful TWOC.

Conclusion: This study showed a high failure rate of TWOC among BPH patients presenting with AUR despite intake of alpha blockers.

Key words: alpha adrenergic blockers, benign prostatic hyperplasia (BPH), trial without catheter (TWOC)
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