Occurrence Of Acute Urinary Retention Research Articles

Occurrence and Risk Factors for Acute Urinary Retention and Urinary Tract Infection in Patients Undergoing Urinary Drainage after Colorectal Resection.

This study aimed to explore the occurrence of acute urinary retention (AUR) and urinary tract infection (UTI) in patients undergoing urinary drainage after colorectal resection and analyse the risk factors. Clinical data of 167 patients with urinary drainage after colorectal resection in Affiliated Qingdao Central Hospital of Qingdao University, Qingdao Cancer Hospital from November 2020 to November 2022 were retrospectively analysed. Clinical data included age, gender, diabetes, hypertension, lesion location, surgical method, previous history of abdominal surgery, urinary system diseases (urinary calculi, benign prostatic hyperplasia and urethral stricture), use of antibiotics before surgery, use of analgesic and sedative drugs after surgery, postoperative extubation time and postoperative adhesive intestinal obstruction. The postoperative AUR and UTI in patients were statistically analysed. Univariate and multivariate logistic regression analyses were used to explore the risk factors and odds ratio (OR) for AUR and UTI. The incidences of AUR and UTI were 23.95% (40/167) and 16.77% (28/167). Patients were divided into AUR group (n = 40), non-AUR group (n = 127), UTI group (n = 28) and non-UTI group (n = 139). Logistic regression analysis showed that previous history of abdominal surgery (OR = 3.517, 95% CI: 1.005-12.313), urinary system diseases (OR = 8.253, 95% CI: 2.692-25.303), postoperative extubation time (OR = 0.536, 95% CI: 0.393-0.732) and postoperative adhesive intestinal obstruction (OR = 25.293, 95% CI: 6.747-94.827) were risk factors for AUR in patients with urinary drainage after colorectal resection (p < 0.05). Female (OR = 21.569, 95% CI: 1.094-425.138), long postoperative extubation time (OR = 26.218, 95% CI: 3.318-207.151) and urinary system diseases (OR = 8.647, 95% CI: 3.425-21.831) were risk factors for UTI in patients undergoing urinary drainage after colorectal resection (p < 0.05). Age and preoperative use of antibiotics were not key influencing factors for UTI (p > 0.05). Clinical attention is paid to high-risk factors and groups. Corresponding interventions are taken as soon as possible to reduce the occurrence of AUR and UTI and further improve the prognosis of patients with urinary drainage after colorectal resection.

Lymphome prostatique: une cause rare de rétention urinaire: à propos d'un cas

Prostate lymphomas (LP) are rare, fewer than 300 cases have been reported in the literature. Each time they are a diagnostic surprise as is the case with our study that is typical, didactic and reports the thirteenth case of prostatic lymphoma in the marginal zone. The study involved a 65-year-old patient, with no particular previous history who presented with signs of prostatism lasting for 4 months, aggravated by the occurrence of acute urinary retention. The diagnosis of benign prostatic hyperplasia with normal prostate-specific antigen (PSA) level was easily made and the patient underwent transurethral resection. To our surprise, the histological study revealed a massive infiltration of prostatic tissue by a non-Hodgkin lymphoma (NHL), marginal zone lymphoma (MZL) subtype. According to Steuter, it was classified as prostatic lymphoma stage IVB with leukemic transformation. The patient has experienced remission for 18 months with normalization of LDH after R-chop therapy. Although rare, these sites of occurrence should be suspected, LDH assay should be systematic in patients with prostatic signs and normal PSA levels. Prognosis is variable, according to age, histologic type and evolutionary stage, however, the median overall survival is identical for primary and secondary forms.

Serum interleukin 6 and acute urinary retention in elderly men with benign prostatic hyperplasia in China: a cross-sectional study.

BackgroundWhile acute urinary retention (AUR) is a severe complication of benign prostatic hyperplasia (BPH), it can also indicate the progression of this common disease in aging men. This study aimed at exploring the possible relationship between serum interleukin 6 (sIL-6) and AUR in BPH patients.MethodsA cross-sectional study was conducted based on 256 elderly men with BPH in China. The association between the sIL-6 level and the occurrence of AUR was evaluated by univariate and multivariable logistic regressions. The receiver operating characteristic (ROC) curve was utilized to determine the discriminant validity of the sIL-6 level and the optimal cut-off value.ResultsThe concentration of sIL-6 was significantly elevated in the AUR group (P<0.001). A positive correlation was observed between the sIL-6 level and AUR in BPH patients [odds ratio (OR) =1.365, 95% confidence interval (CI): 1.174–1.586, P<0.001]. Based on the ROC curve analysis for sIL-6, the optimal cut-off point of 4.475 pg/mL was set to identify the occurrence of AUR in these patients [area under the curve (AUC) =0.7596, 95% CI: 0.6976–0.8216, P<0.001]. A high sIL-6 level (≥4.475 pg/mL) had a significantly stronger correlation with AUR (OR =9.666, 95% CI: 4.347–21.491, P<0.001).ConclusionsThere was a positive correlation between the sIL-6 level and the occurrence of AUR in elderly Chinese patients with BPH. This study provides potential strategies for the screening of BPH individuals with a possible risk of AUR, which may contribute to the early implementation of effective interventions to improve the quality of life and prognosis. Long-term prospective studies are still required to further illustrate the causal relationship.

Subsequent risk of acute urinary retention and androgen deprivation therapy in patients with prostate cancer: A population-based retrospective cohort study.

Acute urinary retention (AUR) is associated with hormone imbalance in men. However, limited studies focused on exploring the complications of AUR in patients with prostate cancer (PC) who receive androgen deprivation therapy (ADT). Therefore, we aim to evaluate the subsequent risk of AUR in ADT-treated PC patients. We collected data from 24,464 male patients who were newly diagnosed with prostate malignancy from a longitudinal health insurance database of catastrophic illness in 2000 to 2008. All PC patients were categorized into 2 cohorts, namely, ADT cohort and non-ADT cohort, based on whether or not the patient receives ADT. The patients were followed up until the occurrence of AUR. Multivariate Cox proportional hazard regression and Kaplan–Meier analysis were performed. After a 12-year follow-up, the incidence rates of AUR were 12.49 and 9.86 per 1000 person-years in ADT and non-ADT cohorts, respectively. Compared with the non-ADT cohort, the ADT cohort had a 1.21-fold increase in AUR risk based on the adjusted model (95% CI = 1.03–1.43). In addition, PC patients receiving early ADT treatment within 6 months or receiving only luteinizing hormone-releasing hormone treatment also had significantly increased risk of AUR. ADT was positively associated with AUR risk. PC patients receiving ADT should be informed about the risks of bladder outlet obstruction and AUR, and they may benefit from screening for related risk factors. New guidelines and treatments should be proposed in the future to manage ADT-related lower urinary tract symptoms and reduce the risk of AUR.

Ideal timing of indwelling catheter removal after robot-assisted radical prostatectomy with a running barbed suture technique: a prospective analysis of 425 consecutive patients

ObjectiveTo compare prospectively early outcome and complications of catheter removal after robot-assisted radical prostatectomy (RARP) on the 4th or 7th day with a standardized running barbed suture technique.IntroductionThe time point of removing the indwelling catheter after RARP mainly depends on institute’s/surgeon’s preferences. Removal should be late enough to avoid urinary leakage and complications such as acute urinary retention (AUR) but early enough to avoid unnecessary catheter indwelling.Materials and methodsA consecutive single-institutional series of patients underwent RARP between July 2015 and August 2017 and were entered in a prospectively maintained data base. Between July 2015 and December 2016 a cystogram was performed on 7th postoperative day (group A), thereafter the cystogram was performed on 4th postoperative day (group B). Incidence of acute urinary retention (AUR), urinary tract infections (UTI) and adverse events between the two cohorts was compared.Results425 patients were analyzed (group A: n = 231; group B: n = 194). Both cohorts were comparable regarding demographic and oncological parameters. Watertight anastomosis was present in 84.8% in group A and in 82.5% in group B, respectively. AUR within 4 weeks after RARP occurred in 2.2% (n = 3) in A and 9.4% (n = 15) in B (p = 0.001). AUR within 72 h after catheter removal occurred in group A: 1% (n = 2) and in group B: 6.3% (n = 10) (p = 0.005). Symptomatic urinary tract infections occurred in 8.2% (n = 16) in group A and in 6.9% (n = 11) in group B. There were no differences in the rate of secondary anastomosis dehiscence. Age, BMI, prostate size, surgeon, or intraoperative bladder neck reconstruction were not correlated to the occurrence of AUR or UTI.ConclusionsThe removal of indwelling catheter on day 4 after a RARP with a running barbed suture shows similar anastomosis leakage rates as on the 7th postoperative day. However, AUR rates are higher for early removal. Patients scheduled for early removal should be carefully informed about the increased risk for AUR. Catheter indwelling time does not represent a risk factor for UTI.

Acute urinary retention secondary to buprenorphine administration

Urinary retention is associated with buprenorphine, particularly with epidural/intrathecal delivery. However, it is rare with oral administration. This case report illustrates an occurrence of acute urinary retention after initiation of oral buprenorphine/naloxone.

Clinical Progression, Acute Urinary Retention, Prostate-Related Surgeries, and Costs in Patients with Benign Prostatic Hyperplasia Taking Early Versus Delayed Combination 5α-Reductase Inhibitor Therapy and α-Blocker Therapy: A Retrospective Analysis

BackgroundTwo previous retrospective database analyses compared early combination therapy with an α-blocker (AB) and 5-α reductase inhibitor (5-ARI) to delayed combination therapy and found that patients receiving the delayed combination therapy were more likely to have clinical progression, acute urinary retention (AUR), and surgery. Although these studies indicate the clinical benefits of early treatment, both studies failed to take into account important baseline clinical measures, such as prostate-specific antigen (PSA) values. ObjectiveThis study was designed to compare clinical and cost differences in men with benign prostatic hyperplasia (BPH) who initiated early versus delayed combination therapy with a 5-ARI + an AB, factoring in baseline PSA values. MethodsThis retrospective claims data analysis assessed data from >14 million US men with linked medical data, pharmacy data, laboratory results, and enrollment information from January 1, 2000, to December 31, 2009. Men aged 50 or older and treated for BPH with a 5-ARI + an AB were identified. Patients were required to be eligible for services at least 6 months before and 12 months after the index medication date. Patients were assigned to 1 of 2 treatment groups based on therapy (early or delayed) and 3 cohorts based on availability of PSA laboratory values (patients with a PSA value, patients with a PSA value >1.5 and <10, and all patients). Using a logistic model, the likelihood of clinical progression (defined as the occurrence of AUR or prostate surgery) during the 12 months after the date of first prescription fill was compared between BPH patients receiving early versus delayed combination therapy. BPH-related medical costs (excluding pharmacy costs) were assessed using generalized linear models. ResultsAmong the 13,551 patients identified for study inclusion, the highest risks for clinical progression, AUR, and prostate-related surgery were consistently demonstrated in patients with a PSA >1.5 and <10. Across all 3 cohorts, the delayed combination-treatment group was more likely to have clinical progression, AUR, and prostate-related surgeries versus the early combination-treatment group. The incremental difference in BPH-related costs between the delayed and early combination-treatment groups was $190 per patient overall; the greatest incremental difference ($397) was observed in patients with PSA >1.5 and <10. ConclusionsThe results suggest that early initiation of combination therapy with 5-ARI + an AB, compared with delayed initiation, can reduce the risks for clinical progression, AUR, and prostate-related surgeries, as well as BPH-related medical costs, in patients with BPH.

Difficult Urination Does Not Affect the Successful Outcome after 100U OnabotulinumtoxinA Intravesical Injection in Patients with Idiopathic Detrusor Overactivity.

Intravesical injection of onabotulinumtoxinA (i.e. Botox) provides effective treatment for overactive bladder. However, treatment-related adverse events (AEs) remain problems. This study investigated the effect of AEs after onabotulinumtoxinA injection on the success rate for idiopathic detrusor overactivity (IDO). A total of 174 patients who received the first single intravesical onabotulinumtoxinA 100U injection for refractory IDO were included. The onabotulinumtoxinA related AEs including acute urinary retention (AUR), large postvoid residual (PVR, ≥150 mL), difficult urination, urinary tract infection, gross hematuria and general weakness were recorded. The success rate was determined based on patient perception of bladder condition improved by two scales. The short-term (3 months) and long-term (up to 24 months) success rates were analyzed according to the occurrence of these AEs. A successful outcome was reported by 138 (79.3%) patients at 3 months. AUR occurred in 12 (6.9%) patients, large PVR developed in 81 (46.6%) and 73 (42%) needed straining to void. Gross hematuria occurred in 17 (9.8%) patients, urinary tract infection developed in 27 (15.5%) and general weakness was noted in 6 (3.4%). The occurrence of AUR did not affect the therapeutic results. Patients having large PVR and difficult urination had a significantly higher success rate at 3 months. Long-term success rates up to 24 months showed no significant difference between patients with and without AEs. AEs after intravesical 100U onabotulinumtoxinA for IDO were frequently encountered. However, the occurrence of AUR, large PVR or difficult urination did not affect the final therapeutic outcome.

Opportunity to Optimize Management of Benign Prostatic Hyperplasia

Five-alpha reductase inhibitor may be underused and their value underappreciated in nursing home residents with enlarged prostates due to BPH. Initiation of a 5-alpha reductase inhibitor with an alpha-1 selective blocker may reduce the occurrence of acute urinary retention, decrease the risk of developing incontinence, and avoid or significantly delay the need for surgical intervention in this highly vulnerable male population.

Adverse Events of Intravesical Botulinum Toxin A Injections for Idiopathic Detrusor Overactivity: Risk Factors and Influence on Treatment Outcome

BackgroundIntravesical injection of botulinum toxin type A (BoNTA) provides effective treatment for detrusor overactivity and overactive bladder (OAB). However, the high rates of treatment-related adverse events (AEs) prevent its more widespread use. ObjectiveTo investigate the risk factors of increasing AEs after BoNTA injection for idiopathic detrusor overactivity (IDO). Design, setting, and participantsThis study included a total of 217 patients receiving their first intravesical BoNTA injection for refractory IDO in a tertiary university hospital from 2004 to 2009. MeasurementsAE incidence was analyzed according to gender, age, comorbidities, prostate condition in men, OAB subtype, BoNTA dose, injection site, and baseline urodynamic parameters. Successful outcome was determined based on patient perception of improvement of bladder condition at 3 mo. Results and limitationsSuccessful outcomes were reported by 144 (66.3%) patients. By multivariable analysis, male gender (p=0.013) and baseline postvoid residual (PVR) ≥100ml (p=0.003) were independent predictors of acute urinary retention (AUR). Baseline PVR ≥100ml (p=0.007) and receiving >100 U BoNTA (p=0.029) were predictors of straining to void. The incidence of large PVR after treatment was associated with comorbidity (p=0.011). Urinary tract infection occurred more frequently in women (p=0.003) and in men with retaining prostate (p=0.008). No AUR developed after bladder base/trigonal injection. Nevertheless, the occurrence of AUR or large PVR did not affect therapeutic outcome. This study is limited by nonconsecutive enrollment of patients. ConclusionsMale gender, baseline PVR ≥100ml, comorbidity, and BoNTA dose >100 U are risk factors for increasing incidence of AEs after intravesical BoNTA injection for IDO.

Open prostatectomy for benign prostate hyperplasia: short-term outcome in 3000 consecutive patients

The purpose of this study was to report the short-term results of open prostatectomy for benign prostatic hyperplasia (BPH). Patient charts were retrospectively reviewed from September 1988 to April 2004. A total of 3000 consecutive patients with bothersome lower urinary tract symptoms (LUTS) and complications of BPH underwent open prostatectomy in our center. We routinely used a retropubic, transcapsular approach with spinal anesthesia. Mean age was 69 years. Three hundred and sixty one patients were 80 years or older. Mean prostate volume was 71 ml. One thousand eight hundred and twenty five patients (60.8%) presented with and were operated on for acute urinary retention (AUR), and 350 patients (11.7%) presented with and were operated on for urge/overflow urinary incontinence. The main reasons for delayed presentation were poverty and absence of real medical insurance, because in Iran 'insured' patients pay at least 60% of their medical expenses personally. Reoperation in the same admission was needed in 29 patients (1%). Transfusions were needed in 99 patients (3.3%). Wound infection occurred in 37 patients (1.2%). Acute myocardial infarction (MI) occurred in 15 patients (0.5%), resulting in three deaths. Occurrence of AUR had significant negative correlation with duration of symptoms (P<0.05; odds ratio 0.5), and significant positive correlation with positive urine culture (P<0.05; odds ratio 2.7). Duration of hospital stay had significant positive correlation with positive urine culture (P<0.05; odds ratio 1.6) and advanced age (P<0.05; odds ratio 1.8), and significant negative correlation with prostate volume (P<0.05; odds ratio 0.6). Our results are representative of the current status of open prostatectomy. Whenever minimally invasive therapies are not affordable retropubic prostatectomy is a practical alternative.

Definition of at‐risk patients: baseline variables

Benign prostatic hyperplasia (BPH) represents a significant burden in ageing men due to frequently associated lower urinary tract symptoms (LUTS), which may impair their quality of life. Some men will have progressive disease, mainly characterized by symptom deterioration of > or = 4 points on the International Prostate Symptom Score, but also by the occurrence of acute urinary retention (AUR) and BPH-related surgery. Identifying those at risk of unfavourable outcomes is important to optimize their management. Community-based longitudinal studies provide excellent data on the natural history of BPH. Baseline variables such as age, severe LUTS, low peak flow rate, high postvoid residual urine volume (PVR), enlarged prostate and high serum prostate-specific antigen (PSA) levels, have been identified as risk factors for AUR and BPH-related surgery in such studies. Placebo arms of controlled studies have more limited value for assessing the natural history, due to strong selection criteria which generate a regression to the mean artefact and narrow the applicability to the general population. Nevertheless, in these controlled studies, baseline serum PSA level and to a lesser extent prostate size consistently predicted the risk of AUR and BPH-related surgery. Conversely, quantitative variables such as baseline symptom severity and peak flow rate behaved paradoxically, probably as a consequence of strict inclusion criteria, resulting regression to the mean, and 'ceiling' effects. Results from the Medical Therapy of Prostatic Symptoms study and the Alfuzosin Long-Term Efficacy and Safety Study also suggest that using the PVR in clinical practice needs to be reconsidered as a predictor of BPH progression. Further research is needed to clarify the role of chronic inflammation in the process of BPH progression.

Natural history and clinical predictors of clinical progression in benign prostatic hyperplasia

Prevalence of benign prostatic hyperplasia (BPH) is increasing with the aging population worldwide. Knowledge of the natural history of BPH is crucial for primary, secondary and tertiary prevention of its progression. This review examines the evidence of the natural history of BPH, highlighting the group of patients with mild symptoms and the risk factors for progression. Several community and clinical studies have demonstrated the progressive nature of BPH. Different surrogate endpoints, which include symptom score, peak urinary flow rate, prostate volume, and the occurrence of acute urinary retention and need for surgery, have been described. Prostatic specific antigen and prostate volume are the two most common predictors of clinical progression and are helpful to the clinician for identifying high-risk patients. With further understanding of the natural history and the predictors of progression of BPH, management can be better tailored according to risk stratification and the results of clinical trials of effectiveness can be better interpreted.

Diabetes and benign prostate hyperplasia in Olmsted County, Minnesota

Purpose The incidence of diabetes (DM) has increased rapidly. Recent studies have shown an association between DM and benign prostate hyperplasia (BPH). These studies, however, have been limited by cross-sectional data without long-term follow-up and lacked population-based samples. We examined the association of DM and BPH in a prospective population-based sample of residents of Olmsted County, Minnesota, with serial surrogate measures of BPH. Methods A cohort of 2115 Caucasian men aged 40 to 79 years was randomly selected from an enumeration of the 1990 Olmsted County, Minnesota, population (55% participation rate). Participants completed a previously validated baseline questionnaire that assessed lower urinary tract symptom severity with questions similar to the AUA Symptom Index (AUASI); a composite AUASI was estimated. The questionnaire also asked whether they had ever been diagnosed by a physician as having DM. Participants voided into a portable urometer to measure peak urinary flow rates ( Q max ). A 25% random subsample underwent transrectal sonographic imaging to determine prostate volume (PVOL). Dynamic follow-up was performed biennially for about 10 years and supplemented with the review of community medical records for documented occurrence of acute urinary retention (AUR). A two-stage slope was calculated for AUASI and Q max . Results A total of 111 (4.6%) of the men had DM at baseline. The mean age was 63.0 (SD = 10.8) and 54.2 (SD = 10.5) years in those with and without DM. Mean body mass index at baseline was 29.3 (SD = 5.4) and 27.0 (SD = 4.0) in those with and without DM. Individuals with DM had significantly greater mean percentage change in AUASI (0.42 vs. 0.16; P = 0.03) and Q max (4.6% vs. 2.2%; P = 0.04) compared with those without DM; however, there was no difference in change in PVOL or in occurrence of AUR. Conclusion Compared with men without DM, individuals with DM at baseline had significantly greater progression of BPH, as measured by surrogate markers AUASI and Q max , but not PVOL or AUR, during follow-up. Study results suggest that the presence of DM may be more closely associated with the dynamic components of lower urinary tract function than with BPH.

Seasonal Variation in the Occurrence of Acute Urinary Retention

Objective: To determine whether acute urinary retention shows a seasonal variation. Methods: All acute urinary retentions observed in the emergency room of St. Anna Hospital, Ferrara, along an eight-year period (1991–1998) were considered. Diagnosis was made on the basis of history, physical examination, and bladder drainer by insertion of a catheter with registration of the retained urinary volume. The main determining cause of the acute urinary retention event was tentatively determined. Month and day of each event were categorized both by seasons and monthly intervals. For statistical analysis chi-square test for goodness of fit and partial Fourier series were used. Results: 1,133 acute urinary retention events were observed in 929 different subjects (871 males, 58 females). In 738 cases it was possible to define the main determining cause of the event. The seasonal distribution showed a higher frequency peak of events in summer and autumn both for total population and males subgroup. Analysis by determining cause of the event demonstrated a greater frequency of events in summer only in patients with prostatic hypertrophy. Chronobiologic evaluation showed a circannual pattern for acute urinary retention, both for total sample and male subgroup, with a significant peak in late summer (August–September). Analysis by main determining cause revealed a similar circannual pattern only for cases of acute urinary retention determined by prostatic hypertrophy. Conclusions: The present study shows that acute urinary retention exhibits a circannual distribution in its occurrence, particularly when caused by prostatic hypertrophy.

Comparison of the efficacy and safety of finasteride in older versus younger men with benign prostatic hyperplasia

Objectives. To compare the efficacy and safety of finasteride 5 mg in older (65 years old or older) versus younger (45 to younger than 65 years old) men with benign prostatic hyperplasia (BPH). Methods. The Proscar Long-Term Efficacy and Safety Study (PLESS) was a 4-year, randomized, double-blind, placebo-controlled trial assessing the efficacy and safety of finasteride 5 mg in 3040 men 45 to 78 years old with symptomatic BPH, enlarged prostates, and no evidence of prostate cancer. The endpoints included urinary symptoms, prostate volume, occurrence of acute urinary retention and/or BPH-related surgery, and safety. Results. In both age cohorts, finasteride treatment led to a 51% reduction ( P <0.001) in the relative risk for acute urinary retention and/or BPH-related surgery, a significant ( P <0.001) and durable improvement in symptom score, and a significant ( P <0.001) and sustained reduction in prostate volume. Within each age cohort, no significant differences were found between the placebo and finasteride-treated patients in the incidence of cardiovascular adverse events. Significant differences were evident between the placebo and finasteride groups in the incidence of the typical, known, drug-related adverse events, but no specific differences were associated with age. No drug interactions of clinical importance were observed in the finasteride-treated patients. Conclusions. The present analysis from PLESS demonstrates that in both older (65 years old or older) and younger men with symptomatic BPH and enlarged prostates, finasteride is highly effective in improving symptoms and reducing prostate volume in many men and in reducing the risk of acute urinary retention and BPH-related surgery. In addition, the safety profile of finasteride in both older and younger men is similar and no drug interactions of clinical importance were observed.

Do Alpha-Blockers Prevent the Occurrence of Acute Urinary Retention?

Acute urinary retention (AUR) is a common complication of benign prostatic hyperplasia (BPH) and the incidence varies widely from 0.4 to 25% per year in men seen in urology practices. It has been estimated that AUR is the indication for surgery in around 25–30% of patients undergoing transurethral resection of the prostate (TURP) and that emergency TURP for AUR is associated with greater morbidity than elective TURP. Risk factors for AUR include lower urinary tract symptoms (LUTS), depressed peak urinary flow rate, enlarged prostate, high postvoid residual (PVR) urine and old age. Alfuzosin has been shown to significantly increase maximum flow rate and relieve bladder outlet obstruction, resulting in a reduction in PVR urine. A pooled analysis of 11 placebo-controlled studies involving 1,470 patients with LUTS suggestive of BPH indicates that significantly greater improvements were observed in patients treated with alfuzosin than with placebo. A 6-month placebo controlled study of 518 patients reported a 0.4% incidence of AUR in the alfuzosin group compared with a 2.4% incidence with placebo (p = 0.04). These positive effects on PVR could be related to the reduction in incidence of AUR seen in alfuzosin-treated patients.

Natural History of Prostatism: Risk Factors for Acute Urinary Retention

Purpose We determined the occurrence of and risk factors for acute urinary retention in the community setting. Materials and Methods A cohort of 2,115 men 40 to 79 years old was randomly selected from an enumeration of the Olmsted County, Minnesota population (55% response rate). Participants completed a previously validated baseline questionnaire that assessed symptom severity, and voided into a portable urometer to measure peak urinary flow rates. A 25% random subsample underwent transrectal sonographic imaging of the prostate to determine prostate volume. Followup was performed through a retrospective review of community medical records to determine the occurrence of acute urinary retention in the subsequent 4 years. Results During the 8,344 person-years of followup 57 men had a first episode of acute urinary retention (incidence 6.8/1,000 person-years, 95% confidence interval [CI] 5.2, 8.9). Among men with no to mild symptoms (American Urological Association symptom index score 7 or less) the incidence of acute urinary retention increased from 2.6/1,000 person-years among men 40 to 49 years old to 9.3/1,000 person-years among men 70 to 79 years old. By contrast, rates increased from 3.0/1,000 person-years for men 40 to 49 years old to 34.7/1,000 person-years among men 70 to 79 years old among men with moderate to severe symptoms (American Urological Association symptom index score greater than 7). Men with depressed peak urinary flow rate (less than 12 ml. per second) were at 4 times the risk of acute urinary retention compared with men with urinary flow rates greater than 12 ml. per second (95% CI 2.3, 6.6). Men with an enlarged prostate (greater than 30 ml.) experienced a 3-fold increase in risk (95% CI 1.0, 9.0, p = 0.04). Conclusions Lower urinary tract symptoms, depressed peak urinary flow rates, enlarged prostates and older age are associated with an increased risk of acute urinary retention in community dwelling men. These findings may help to identify men at increased risk of acute urinary retention in whom closer evaluation may be warranted.

Finasteride significantly reduces acute urinary retention and need for surgery in patients with symptomatic benign prostatic hyperplasia

Objectives. A pooled analysis of all available randomized trials with 2-year follow-up data with finasteride and placebo was undertaken to further investigate recent observations that finasteride use may reduce the occurrence of acute urinary retention (AUR) and benign prostatic hyperplasia (BPH)-related surgical intervention. Methods. Occurrences of AUR and surgical intervention were examined by treatment group in a pooled series of 4222 men with moderately symptomatic BPH. Results. In total, 81 occurrences of AUR were reported, 24 (1.1%) of 2113 in the finasteride group and 57 (2.7%) of 2109 in the placebo group. The hazard ratio was consistent in all three studies, with a 57% decrease in the hazard rate for occurrence of AUR with finasteride compared with that for placebo present in the pooled data set over the 2-year study period ( P <0.001). Additionally, 227 surgical interventions were recorded over the 2-year study period, 89 (4.2%) of 2113 in the finasteride group and 138 (6.5%) of 2109 in the placebo group. The hazard ratio was consistent across the three studies, with a 34% reduction in the hazard rate for occurrence of surgery with finasteride compared with that for placebo ( P <0.002). Overall, there was 35% reduction in the two BPH-related end points (ie, AUR or surgery). Conclusions. Treatment with finasteride for up to 2 years more than halves the frequency of AUR and reduces surgical intervention by over one third relative to placebo in patients with moderate BPH. This is the first demonstration that long-term medical therapy can reduce clinically significant end points such as AUR or surgery, and these data have important implications for the long-term management of patients with BPH.