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12-12-2011 | Surgery | Article

Alpha-blockade improves TWOC success rates after urinary retention


Free abstract

MedWire News: Urethral catheterization followed by trial without catheter (TWOC) is the treatment of choice for acute urinary retention (AUR) in men, researchers report.

And the likelihood for successful TWOC doubles if an alpha-1 blocker is used before catheter removal, they add.

The researchers, led by John Fitzpatrick (Saint-Louis Hospital, Paris, France) conducted a survey involving 6074 men from a range of different regions including France (n=2618), Asia (n=1727), Latin America (n=883), Algeria (n=755), and the Middle East (n=91).

All men were admitted to private or public urology practices with AUR.

In all, 71% had spontaneous AUR and the remaining 29% had AUR triggered by factors, such as alcohol excess and anesthesia. Furthermore, benign prostatic hyperplasia (BPH) was found to be an underlying condition in 44% of AUR patients.

AUR hospitalization rates varied between the countries. Specifically, Algeria had the highest threshold for hospitalizing AUR patients, admitting only 1.7% of patients presenting with AUR. By contrast, France admitted all patients that presented with AUR.

The researchers remark that "this obviously reflects major differences between healthcare systems but also questions the necessity of hospitalizing men presenting with AUR."

Irrespective of admission practices, all countries appeared to treat the condition in the same manner, with approximately 90% of all AUR patients receiving urethral catheterization followed by TWOC 3-8 days later.

A TWOC success rate of 61% was observed by the researchers in the group as a whole.

When the outcomes of the men treated with an alpha-1 blocker prior to TWOC (86%) were assessed, Fitzpatrick et al found that TWOC success rate in this group was 92% higher than among men who had no alpha-blockade.

Fitzpatrick commented: "Our study shows that prescribing the patient with an alpha-1 blocker before providing further treatment without a catheter is the most successful route."

Catheterization for more than 3 days before TWOC did not affect success of the TWOC. However, men who were catheterized for this period of time had a higher frequency of ill health and longer in-hospital stay than those catheterized for 3 days or less.

As reported in British Journal of Urology International, age and prostate size were independently associated with TWOC success. Indeed, patients aged 70 years or older were 27% less likely to have a successful TWOC compared with those aged less than 70 years, and men with a prostate volume of greater than 50 g were 37% less likely to have TWOC success than those with a prostate size of 50g or less.

Fitzpatrick and team highlight that at present there are no standardized guidelines for AUR management in countries worldwide.

They conclude that such guidelines are necessary and the use of alpha-1 blockers prior to TWOC should be recommended in AUR-management protocols.

By Lauretta Ihonor

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