Ambulatory care program for patients presenting with acute urinary retention secondary to benign prostatic hyperplasia

Objective We analyze the clinical and economical outcomes of an ambulatory care program for the management of patients presenting to the emergency department with acute urinary retention (AUR). Method A standardized ambulatory care program for managing male patients presenting with AUR was established in October 2007. Prospective data collected in 194 ambulatory patients from January to December 2008 were compared to a historical cohort of 168 patients who were managed by in-patient care from October 2006 to September 2007 for their clinical and economic outcomes. Results For the historical cohort, the mean length of hospital stay was 4.67 +/- 3.34 days and the trial without catheterization (TWOC) success rate was 66.1 %. Two patients (1.2 %) developed dizziness after using alpha(1)-blockers. For the patients in the ambulatory care program, the mean duration of catheterization was 4.72 +/- 2.26 days and the TWOC success rate was 69.1 %. There were four unplanned admissions (2.1 %) among the patients who were managed under the ambulatory care program; three of them had catheter-related complications (i.e., hematuria and urinary tract infection) and one developed dizziness after the use of alfuzosin. All of them were managed accordingly and no unfavorable sequelae were resulted. This new program reduced hospital admission rate of male patients presenting with AUR by 59.1 %. It leads to significant cost reduction of USD 375,614.3 in our hospital in year 2008. Conclusion The ambulatory care program reduced the hospital admission rate and reduced cost without jeopardizing the TWOC success rate and safety in the management of patients presenting with AUR.