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Prostate size influences the outcome after presenting with acute urinary retention
Author(s) -
McNeill Alan S.,
Rizvi Syed,
Byrne Derek J.
Publication year - 2004
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2004.05000.x
Subject(s) - medicine , urinary retention , alfuzosin , bladder outlet obstruction , placebo , prostate , prospective cohort study , prostatectomy , urology , surgery , lower urinary tract symptoms , cancer , alternative medicine , pathology
The relevance of prostatic size to treatment outcome has been stressed by many authors, in terms of likelihood of response to 5α‐reductase inhibitors and as a risk factor for future surgery or acute urinary retention. Authors from Scotland studied patients who developed acute retention and were treated with catheter removal and α‐adrenergic blockage. They found that, in this group of patients, prostate size was the key determinant as to whether surgery would be required or whether the more conservative treatment would be successful. 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 α‐blocker, e.g. alfuzosin, increases the success rate of TWOC. PATIENTS AND 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 α‐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 α‐blockers and/or 5α‐reductase inhibitors after a successful TWOC merits further investigation.