High rate of AUR cases due to precipitating factors

Istanbul, Turkey-New survey findings from France suggests that between one-third and one-half of acute urinary retention cases in patients with BPH are related to precipitating factors such as the use of anesthesia, which was noted in nearly 50% of the survey participants.

The survey also revealed that trial without catheterization performed in this study population resulted in roughly a 70% success rate, which greatly reduced the occurrence of adverse events associated with catheterization.

The prospective cross-sectional survey included 1,201 patients under the care of 720 urologists. First author Francois Desgrandchamps, MD, of the Hopital Saint-Louis, Paris, investigated all cases of patients seen for an incident of non-febrile AUR due to BPH who were managed with transurethral bladder catheterization between May and October 2004. The survey excluded patients with AUR associated with prostate surgery or bladder clots.

"PAUR and SAUR are not the same. Although patients with precipitated AUR were less prevalent than patients with spontaneous AUR, precipitated AUR patients run a high risk of a trial without catheter failure," Dr. Desgrandchamps confirmed in a lecture at the European Association of Urology annual congress.

Out of 1,201 patients included in the survey, 321 had PAUR (27%) and 880 had SAUR (73%). The mean patient age in each group was similar, at 72 years.

The incidence of precipitating factors in AUR cases was anesthesia in 46.2% of cases, fecaloma in 16%, ano-rectal pain in 7.1%, and intake of parasympatholytics in 7.1% of cases. BPH was previously known in 49.2% of PAUR and 74.9% of SAUR patients (p<.001). Large prostate volume in excess of 50 cc was less frequent in the PAUR group (32.6%) than in the SAUR group (52.9%) (p<.001).

Dr. Desgrandchamps addressed the morbidity caused by catheterization in 1,189 eligible patients in this population. Fifty-four patients (4.5%) had at least one complication resulting from the first catheterization. Of these, 18 had hematuria (33%), 23 had urethrorrhagia (42.6%), eight were catheterized the wrong way (14.8%), seven could not be catheterized (13%), and four had other adverse events.

Half of TWOCs successful Based on the outcome of catheterization, the patients went either directly to emergency/planned surgery (30%) or had a trial without catheterization (TWOC) performed by their individual urologist (70%).

Of the first-time TWOCs performed, overall, 51% were successful and 49% failed. Roughly one-third of patients with failed initial TWOC had a second attempt, of which another 21% were successful.

Ninety percent of PAUR cases had TWOC, with a success rate of 56.4%. Just over 60% of SAUR cases had TWOC, with 49.3% success (p<.001 and p<.05 respectively).

Dr. Desgrandchamps explained that the major risk factors that lead to complications are the duration of catheter time and the number of catheterizations performed.

To illustrate, he observed that after 3 days of catheterization, the risk of hematuria or catheter obstruction in this population doubled and patients required prolonged hospitalization.

Similarly, more than one catheter insertion enhanced the risk of complications such as asymptomatic bacteriuria (8.3% after first catheterization vs. 17.9% after second catheterization), lower UTI (2.4% vs. 5.4%), febrile infection (0.5% vs. 2.4%), and urine leak (3.7% vs. 3.8%).

Because AUR is the most serious complication of BPH, all efforts should be made to reduce the duration of catheterization in order to reduce risks, Dr. Desgrandchamps pointed out. Use of TWOC revealed up to 70% success in relieving retention, he emphasized.