Detrusor wall thickness does not predict a successful trial without catheter after acute urinary retention in patients on medical treatment for benign prostatic hyperplasia.

De Nunzio C1, Cancrini F1, Tema G1, Lombardo R1, Nacchia A1, Cindolo L2, Bada M2, Schips L2, Gacci M3, Milanesi M3, Cito G3, Serni S3, Tubaro A1

Research Type

Clinical

Abstract Category

Male Lower Urinary Tract Symptoms (LUTS) / Voiding Dysfunction

Abstract 129
E-Poster 1
Scientific Open Discussion ePoster Session 7
Wednesday 4th September 2019
12:35 - 12:40 (ePoster Station 7)
Exhibition Hall
Benign Prostatic Hyperplasia (BPH) Prevention Voiding Dysfunction
1.Sant'Andrea Hospital, Sapienza University of Rome, Rome Italy, 2.S.Pio da Pietrelcina Hospital, Vasto, Italy, 3.Careggi Hospital, University of Florence, Florence, Italy.
Presenter
F

Fabiana Cancrini

Links

Poster

Abstract

Hypothesis / aims of study
Alpha-blockers are considered the standard treatment for the management of acute urinary retention (AUR) in patients with benign prostatic hyperplasia (BPH). However, no data are available on the predictors of a successful trial without catheter (TWOC) in patients on treatment with alpha blocker +/- 5 alpha reductase inhibitors (5ARI). Aim of our study to investigate predictors of a successful trial without catheter in these patients.
Study design, materials and methods
A consecutive series of patients, on treatment with alpha blockers (AB) +/- 5 ARI, experiencing AUR were prospectively. Patients were evaluated with clinical history, previous medical treatment, uroflowmetry and PSA were recorded. Patients underwent urinary tract ultrasound to evaluate: hydronefrosis, prostate volume, detrusor wall thickness (DWT), intra-vescical prostatic protrusion (IPP). Concomitant urinary tract infections were evaluated and eventually treated. A TWOC was performed seven days after AUR. A post TWOC uroflowmetry with post void residual urine evaluation was performed. Mann-Whitney, chi square and binary logistic regression analysis were performed. Data are presented as median (Inter-quartile Range)
Results
Overall 126 patients were enrolled with a median age of 72 (65/78) years and a median BMI of 25 (23/26) kg/m2. Median prostate volume was 74 (56/102) ml, median DWT was 5 mm (4.6/10) and median IPP was 5 mm (3.5/12). Hydronephrosis, was found in 24/126 (19%) patients. Overall 89/126 (71%) patients were on AB and 37/126 (29%) were on combination treatment.
Interpretation of results
Overall 68/126 (54%) presented a successful TWOC. Patients with a successful TWOC presented smaller prostates (p=0.001), lower IPSS scores (p=0.001) and lower IPP measures (p=0.001), however no differences in terms of DWT measures were found. On multivariate analysis IPSS and IPP<10mm were predictors of a successful TWOC (Table).
Concluding message
Patients with acute urinary retention on treatment with alpha blockers +/- 5 alpha reductase inhibitors still present a 54% probability of a successful trial without catheter. Low IPSS scores and IPP<10mm are predictors of success while DWT couldn’t reach the level of an independent predictor.  Further studies should confirm our results.
Figure 1
Disclosures
Funding None Clinical Trial No Subjects Human Ethics Committee Sant'Andrea Hospital Helsinki Yes Informed Consent Yes