Factors Affecting Trial Without Catheter for First Spontaneous Acute Urinary Retention

Purpose: To find the association of trial without catheter (TWOC) outcome for first spontaneous acute urinary retention (AUR) in benign prostatic obstruction with age, prior lower urinary tract symptoms (LUTS), retention volume at catheterization (RV), and size of prostate. Methods: Our prospective observational analytical (interventional) study enrolled 77 cases of spontaneous AUR over 24 months. After clinical evaluation, digital rectal examination, and transabdominal ultrasonography, all patients were catheterized per urethra and their RV was recorded. TWOC was administered after 2 or 3 doses of 0.4 mg tamsulosin-oral absorption control system and after 48-72 hours had passed. A successful endpoint was defined as a maximum flow-rate, > 5 mL/sec; voided volume, > 100 mL; postvoid residue, < 200 mL; and voiding within 6 hours of catheter removal. Data obtained from 58 patients were analyzed after excluding the cases lost to follow-up and secondary exclusion. Age, RV, duration of LUTS, and prostate volume on examination and ultrasonography (PUSG) were recorded and statistically analyzed. Prostate-specific antigen levels were obtained on follow-up and cases of cancer, as seen on transrectal ultrasound-guided biopsy, were secondarily excluded. Results: The patients had a mean age of 65.89 +/- 8.67 years. Prior LUTS was seen in 35 patients (2.07 +/- 2.91 months). The mean PUSG and RV were 46.81 +/- 20.58 mL and 854.8 +/- 36.26 mL, respectively. Thirty patients underwent a successful TWOC; a mean age of 63.13 +/- 8.58 years (mean +/- standard deviation; unpaired t-test; P = 0.0053) and a PUSG of <= 45 mL (Pearson chi-square test; P = 0.0427) were significantly associated with a successful outcome. Conclusion: There is a significant association between TWOC outcome, age (P = 0.0053), and PUSG (P = 0.0427).