Alpha-blocker raises success of trial without catheter

May 21, 2008

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 study presented here have shown that the administration of an alpha-blocker prior to a TWOC can significantly increase the chances of TWOC success.

A trial without catheter (TWOC) following an average of 3 days of catheterization has become standard practice in men withacute urinary retention (AUR) associated with BPH. Now the results of a study presented here have shown that theadministration of an alpha-blocker prior to a TWOC can significantly increase the chances of TWOC success.

The prospective, multi-national, multicenter study initially included 3,785 men who presented with painful AUR, of whom 2,811(76.2%) had an initial TWOC. The influence of variables that could ultimately affect the success of TWOC, such as age, type ofAUR, amount of drained volume at catheterization, duration of catheterization, and alpha-blocker intake prior tocatheterization, 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 precipitatedAUR. The catheter was removed after an average of 3 days, and an overall success rate of 57.1% was seen. The majority of thestudy patients (82%) received an alpha-blocker before the removal of the catheter and showed consistently greater TWOC successrates, regardless of the duration of catheterization.

On multivariate regression analysis, researchers confirmed that alpha-blocker therapy prior to a TWOC significantly increasedthe likelihood of a successful TWOC (p<.0001).

"Our results confirm that trial without catheter and an alpha-blocker is a highly effective way of reducing the requirementfor surgery in patients with acute urinary retention, particularly if it is a precipitated event," said first author John M.Fitzpatrick MD, of University College Dublin, Ireland.

Results also showed that men who were catheterized for more than 3 days had a slightly greater chance of TWOC success comparedto those patients who were catheterized for 3 days or less (59.6% vs. 56.4%). However, patients with longer catheterizationtimes demonstrated higher rates of adverse events (32.9% vs. 23%). In addition, the study showed that higher rates of TWOCfailure were associated with older age (>70 years), a drained volume at catheterization of more than a liter, andspontaneous AUR.

Dr. Fitzpatrick is consultant/adviser for sanofi-aventis.