Pre-TWOC alpha-blocker reduces urinary retention risk

Paris-Trial without catheter (TWOC) after a median of 3 days' catheterization has become standard practice in France for patients with acute urinary retention associated with BPH, according to results of a prospective, cross-sectional survey assessing current AUR practice patterns. In addition, TWOC was significantly more successful in patients who received treatment with an alpha-blocker prior to a TWOC than it was in patients who did not receive an alpha-blocker, according to Francois Desgrandchamps, MD, who presented the study results at the European Association of Urology annual congress here.

Dr. Desgrandchamps, professor of urology, Saint Louis Hospital in Paris, said that current management of acute urinary retention varies widely between and within countries, and he attributed this to lack of consensus in the type and duration of catheterization and post-catheterization patient management.

Trial without catheter

After initial catheterization, 72.8% of the patients underwent a TWOC after a median of 3 days. Patients with less-severe lower urinary tract symptoms, no significant postvoid residual urine (<50 mL) prior to acute urinary retention, and who did not receive prior conservative treatment were more likely to fall into the TWOC group. On the other hand, patients who had spontaneous acute urinary retention were less likely to undergo a TWOC (66.2%) and were more likely to have either elective (22.1%) or immediate (7.5%) BPH-related surgery than were patients who had precipitated acute urinary retention (89.4%, 7.1%, and 1.1%, respectively).

In total, 1,906 patients underwent a TWOC. Outcomes were known in 1,899 cases. The catheter was successfully removed in 50.2% of cases, regardless of the type of acute urinary retention.

"The obvious benefit of TWOC is that the patients can return home quickly without the discomfort and potential morbidity associated with an in situ catheter. Additionally, in those patients requiring BPH surgery, a TWOC should help reduce the morbidity and mortality that is usually associated with an acute procedure," Dr. Desgrandchamps said.

In the study, 1,505 patients (79%) received an alpha-1 blocker at the time of catheter removal (alfuzosin [Uroxatral], 76%; tamsulosin [Flomax], 6%; and unspecified, 18%). TWOC was found significantly more successful in those patients who received an alpha-1 blocker prior to the TWOC than it was in patients who did not receive an alpha-1 blocker (53.0% vs. 39.6%, p<.001).

Patients who had the TWOC for a shorter period of time experienced a higher success rate (1 day, 69.3%; 2 days, 55.2%) than did patients with a longer catheterization duration (4 to 7 days, 48.6%; >7 days, 45.6%).

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