TRIAL WITHOUT CATHETER: WHAT PREDICTS THE OUTCOME IN ACUTE URINARY RETENTION?

Abstract

To assess the outcome of conservative management by trial without catheter (TWOC) of patients subsequent to acute urinary retention due to bladder outlet obstruction caused by benign prostatic enlargement and to identify factors favouring positive result thereof. Methods: Cross sectional prospective case review study was conducted in Urology Department of PNS Shifa, Karachi, from August 2016 to March 2018. All patients presenting in emergency department with primary acute urinary retention caused by benign prostatic enlargement underwent trial without catheter, after initial catheterization to relieve retention. The variables recorded were: the duration and type of any previous lower urinary tract symptoms, prior retention episodes, associated anticholinergic medication, any precipitating cause of AUR, urine drained on catheterization and prostate size. Those who voided successfully after removal of catheter were followed up and their urinary flow rate measurement and ultrasonographic measurement of the post-void residual urine were recorded. Results: Of the 99 patients with AUR, 68 (68.6%) voided spontaneously after removing the catheter and continued to do so with mean peak flow rates of 10.3 mL/s and mean PVRs of 114 mL over a follow-up period of 5 to 13 months. These men had a mean prostate size of 39.2gm and a mean catheterized residual volume of 731 mL, while in those who had unsuccessful TWOC the mean prostate size was 63.7 gm (p=0.006) and a mean post catheterized residual volume of 1153 mL (p=0.08). Prostate size as assessed by the DRE was the most significant factor in predicting the outcome of trial without catheter. Conclusion: Trial without catheter is an acceptable protocol in the management of patients after an episode of acute urinary retention due to benign prostatic enlargement. The most significant factor for predicting the outcome of such a trial is size of prostate.