Very high residual volumes should not prevent transurethral resection of the prostate being offered to men presenting with urinary retention

Abstract

Objective.The aim of this study was to identify factors at presentation that can help to predict outcomes and guide subsequent management decisions in patients with acute on chronic retention. Material and methods. The medical notes of 187 consecutive patients presenting with urinary retention at two teaching hospitals between 2008 and 2009 were reviewed. All patients were followed up for a minimum of 3 years. All patients were catheterized at presentation. The majority then underwent one or more of trial without catheter (TWOC), transurethral resection of the prostate (TURP) (both considered successful if the patient voided with a subsequent postvoid residual volume of <200 ml on three successive occasions) or long-term catheterization. Patient factors such as age, associated acute kidney injury (AKI), performance status, residual volume, prior lower urinary tract symptoms (LUTS), treatment of LUTS, diagnosis of diabetes and neuropathy were recorded. Results.Increasing age (p = 0.002) and increasing residual volume (p = 0.046) were associated with a significant increase in the failure of TWOC. The rate of AKI increased significantly with residual volume (p < 0.0001). As residual volume increased so did the likelihood that a patient would undergo TURP (p = 0.0009). Age did not appear to influence the outcome of TURP (p = 0.17). Increasing residual volume did not significantly reduce the likelihood of successful TURP (p = 0.068). Conclusions.High residual volumes should not preclude TURP. There is a clear correlation between AKI and residual volume. Increasing age and residual volume both reduce the likelihood of successful TWOC.

Key Words::

• acute kidney injury
• bladder outflow obstruction
• transurethral resection of the prostate
• trial without catheter
• urinary retention

Declaration of interest: The authors declare that they have no conflict of interests.