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Minerva Urologica e Nefrologica 2020 Nov 17

DOI: 10.23736/S0393-2249.20.04088-6


language: English

Ultrasound prostate parameters as predictors of successful trial without catheter after acute urinary retention in patients ongoing medical treatment for benign prostatic hyperplasia: a prospective multicenter study

Cosimo DE NUNZIO 1 , Olivia VOGLINO 1, Antonio CICIONE 1, Giorgia TEMA 1, Luca CINDOLO 3, Maida BADA 3, Riccardo LOMBARDO 1, Antonio NACCHIA 1, Alberto TRUCCHI 1, Luigi SCHIPS 3, Mauro GACCI 2, Martina MILANESI 2, Gianmartin CITO 2, Sergio SERNI 2, Andrea TUBARO 1

1 Department of Urology, Università La Sapienza, Ospedale Sant’Andrea, Rome, Italy; 2 Department of Urology, Univesità di Firenze Ospedale Careggi, Florence, Italy; 3 Department of Urology, Ospedale S.Pio da Pietrelcina, Vasto, Chieti, Italy


BACKGROUND: Alpha-blockers (ABs) are considered the standard treatment after initial management of acute urinary retention (AUR). However, no data are available on the predictors of a successful trial without catheter (TWOC) in patients previously on treatment with ABs and 5alpha reductase inhibitors (5ARI). Aim of our study was to investigate prostate ultrasound parameters as predictors of TWOC outcome.
METHODS: A consecutive series of patients, on treatment with ABs alone or in combination with 5ARI, experiencing AUR were prospectively enrolled. Clinical data (i.e.age, body mass index (BMI) and IPSS), urinary ultrasound features including hydronephrosis, prostate volume-TRUS, bladder wall thickness (BWT), intravesical prostatic protrusion more than 10mm (IPP≥10) were related to TWOC outcome performed seven days after AUR. A binary logistic regression analysis was computed to detect predictors of successful TWOC.
RESULTS: Overall,143 patients with a median age of 72 years (IQR 64-77) were enrolled. Seventy-mine patients (54%) with smaller prostate volume (59(IQR 52-74) Vs 99 (IQR 74-125) ml, p=0.008) and a thinner BWT (5(IQR 4.8-5.2) Vs 5.2 (4.7-5.5) mm p=0.001) recovered voiding at TWOC. IPP≥10 was less common in patients with successful TWOC 11(14%) vs 33(52%), p=0.001. On multivariate analysis, IPP<10mm (OR 6.10 (95%CI 2.61-14.20), p=0.001), lower IPSS (OR 0.95 (95%CI 0.89-0.99), p= 0.045), smaller TRUS (OR 0.96 (95%CI 0.95-0.97), p=0.001), thinner BWT OR 1.23 (95%CI 0.73-0,92) p=0.001were the independent predictors of voiding recovery.
CONCLUSIONS: Patients receiving medical treatment for BPH and experiencing AUR still present a 54% probability of a successful TWOC. Ultrasound may help to identify patients with successful TWOC.

KEY WORDS: Urinary retention; Bladder wall thickness; BPH; Lower urinary tract symptoms

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