A trial without catheter (TWOC) following an average of 3 days of catheterization has become standard practice in men with acute urinary retention (AUR) associated with BPH. Now, the results of a recent study have shown that the administration of an alpha-blocker prior to a TWOC can significantly increase the chances of the success of TWOC.
Milan, Italy-A trial without catheter (TWOC) following an average of 3 days of catheterization has become standard practice in men with acute urinary retention (AUR) associated with BPH. Now, the results of a recent study presented at the European Association of Urology Annual Congress have shown that the administration of an alpha-blocker prior to a TWOC can significantly increase the chances of the success of TWOC.
The prospective, multinational, multicenter study initially included 3,785 men who presented with painful AUR, of which 2,811 (76.2%) had an initial TWOC. The influence of variables that could ultimately affect the success of TWOC such as age, type of AUR, amount of drained volume at catheterization, duration of catheterization, and alpha-blocker intake prior to catheterization were all analyzed.
Results showed that of the 2,811 patients who underwent a TWOC, 1,824 (65%) had spontaneous AUR and 987 (35%) had precipitated AUR. The catheter was removed after an average of 3 days, and an overall success rate of 57.1% was seen. The majority of the study patients (82%) received an alpha-blocker before the removal of the catheter and showed consistently greater TWOC success rates, regardless of the duration of catheterization. On multivariate regression analysis, researchers confirmed that alpha-blocker therapy prior to a TWOC significantly increased the likelihood of a successful TWOC (p<.0001).
Results also showed that men who were catheterized for more than 3 days had a slightly greater chance of TWOC success compared to those patients who were catheterized for 3 days or less (59.6% vs. 56.4%). However, patients with longer catheterization times demonstrated higher rates of adverse events (32.9% vs. 23%). In addition, the study showed that higher rates of TWOC failure were associated with older age (>70 years), a drained volume at catheterization of more than a liter, and spontaneous AUR.
"In the majority of cases, the alpha-blocker was delivered for 3 days prior to removal of the catheter, usually being started at the time of insertion of the catheter," Dr. Fitzpatrick said. "However, in the case of urologists who only left the catheter in for 1 day, there did not appear to be any decrease in efficacy of the alpha-blocker. In 70% of cases, alfuzosin [Uroxatral] was the alpha-blocker used, and in all cases, the standard dosage of drug was used."
The main adverse events, particularly urosepsis and UTI, were more prevalent when the catheter was left in place for more than 3 days.
Dr. Fitzpatrick is consultant/adviser for sanofi-aventis.