Acute Urinary Retention Rates Research Articles

Complication rate across the minimally invasive surgical treatments (MISTs): where do we stand? A systematic review of the literature.

Over the past decade, the range of surgical options to benign prostatic obstruction (BPO) has expanded significantly with the advent of minimally invasive surgical therapies (MISTs). Nevertheless, the available evidence in the field is heterogeneous. Efficacy and safety thresholds are yet to be determined. To evaluate perioperative and long-term complications after MISTs - including Aquablation, steam injection (Rezūm), Transperineal laser ablation of the prostate (TPLA), implantation of a prostatic urethral lift (PUL) and temporary implantable nitinol device (iTIND) - in patients with lower urinary tract symptoms due to BPO. A systematic literature search was conducted in January 2024 using Medline (via PubMed), Embase (via Ovid), Scopus, and Web of Science. The search strategy used PICO criteria (Patients, Interventions, Comparisons, Outcomes) [1], focusing specifically on patients with BPH-associated LUTS who underwent MIST or other comparative treatments, aiming to assess both perioperative and long-term safety outcomes. Article selection was conducted in accordance with the PRISMA guidelines. The risk of bias and the quality of the articles included were assessed. A dedicated data extraction form was used to collect the data of interest. The initial electronic search identified 3660 records, of which 24 ultimately met the inclusion criteria and were included in the analysis. Overall, Aquablation was associated with a higher major complications rate of 14% (IQR 6-22), particularly in the case of patients with prostates <70 ml. PUL showed a higher early postoperative acute urinary retention rate (10.9%, IQR 9.2-12.3%), while 1.4% of patients treated with iTIND experienced major perioperative complications. Urinary tract infections were mostly reported in series assessing TPLA and Rezūm. The adoption of MISTs for LUTS due to BPH is associated with a varied spectrum of perioperative and long-term complications. Our findings showed an acceptable safety profile with specific complications dependent on the type of MIST performed, highlighting the importance of individualized patient selection and procedure-specific considerations.

Do alpha blockers reduce the risk of urinary retention post-transperineal prostate biopsy? A systematic narrative review.

Transperineal Prostate Biopsy (TPB) is a commonly used technique for the diagnosis of prostate cancer due to growing concerns related to infectious complications associated with transrectal ultrasound-guided prostate biopsy (TRUSB). TPB is associated with an infective complication rate of near zero, however, acute urinary retention (AUR) remains the leading complication causing morbidity. Previously in TRUSB, there was weak evidence that alpha-blockers reduce AUR rates, and their usage has been extrapolated to clinical practice with TPB. This review aims to explore if there is an evidence base for using alpha-blockers to prevent AUR following TPB. A systematic approach was used to search Ovid Medline and Embase using keywords related to "Transperineal" and "Retention". Articles were then screened by applying inclusion and exclusion criteria to find studies that compared alpha-blocker recipients to no alpha-blocker use in the perioperative period and the subsequent effect on AUR in TPB. 361 records were identified in the initial search to produce 5 studies included in the final review. No randomised controlled trials (RCTs) were identified. One observational study showed a reduction in AUR rate from 12.5% to 5.3% with a single dose of tamsulosin. A previous systematic review of complications associated with prostate biopsy concluded there may be a potential benefit to alpha-blockers given in the TPB perioperative period. Three observational studies demonstrated a harmful effect related to alpha-blocker use; however, this was well explained by their clear limitations. Based on this review and the extrapolation from TRUSB data, perioperative alpha-blockers may offer some weak benefits in preventing AUR following TPB. However, there is significant scope and need for an RCT to further develop the evidence base further given the significant gap in the literature and lack of a standard alpha blocker protocol in TPB.

Perioperative alpha blockers in voiding dysfunction secondary to prostate biopsy: A meta-analysis.

Voiding dysfunction remains a common side effect postprostate biopsy leading to significant morbidity. Alpha blockers have emerged as a potential therapeutic option to mitigate this risk, with various centres already incorporating its use in practice. Despite this, the literature regarding its efficacy remains inconclusive. Hence, a systematic review was performed to quantify the effect of perioperative alpha blockers on prostate biopsy-related voiding function. A systematic search in MEDLINE, Embase and PubMed between January 1989 and July 2023 was performed to identify relevant articles. Two independent reviewers independently screened abstracts, full texts and performed data extraction. Data including International Prostate Symptom Scores (IPSS), voiding flow rates (Qmax), postvoid residuals (PVR), rates of acute urinary retention (AUR) and quality of life (QoL) scores were extracted. Results were combined in an inverse variance random effects meta-analysis. A total 808 patients from six randomised controlled trials (RCTs) comparing alpha blockers to controls were included. All articles excluded patients with pre-existing voiding dysfunction. Pooled outcomes demonstrated statistically significant differences favouring alpha blocker usage in all objective and subjective measures including IPSS (mean difference 4.21, 95% confidence interval [CI] 2.58-5.84, p <0.00001), PVR (mean difference 20.41 mL, 95% CI 3.44-37.39, p =0.02), Qmax (mean difference 3.07 mL/s, 95% CI 2.55-3.59, p <0.00001), QoL (weighted-mean difference 0.82, CI 0.17-1.48, p =0.01) as well as overall risk of AUR (odds ratio 0.22, CI 0.09-0.55, p =0.001). There was variable heterogeneity (I 2=0-86%) between outcomes. This review highlights the potential role of alpha blockers in improving urinary function and reducing adverse voiding outcomes postprostate biopsy. The standard practice of incorporating the usage of perioperative alpha blockers may be considered to reduce the morbidity of voiding complications secondary to prostate biopsy.

Effects of Prostatic Inflammation on Clinical Outcomes in Patients with Benign Prostate Hyperplasia

Background: Benign prostate hyperplasia (BPH), a non-cancerous enlargement of the prostate gland, prevalently impacts the aging male population, often disrupting the quality of life with its accompanying urinary symptoms. The intersection between BPH and prostatic inflammation has emerged as a focal point in urological research, with inflammation speculated to exacerbate BPH progression and symptoms. Understanding this relationship is pivotal in refining therapeutic approaches and improving patient outcomes. Objective: This study aimed to elucidate the effects of prostatic inflammation on the clinical outcomes of patients with BPH, focusing on symptom progression, treatment efficacy, and long-term complications. Methods: This Study Conducted at Gajju Khan Medical College Swabi, KPK, Pakistan, in the duration from January, 2023 to June, 2023. This prospective cohort study involved 126 men with BPH, categorized into two groups based on the presence (n=63) or absence (n=63) of prostatic inflammation. Data were collected over three years, with assessments including demographic information, clinical histories, and prostate examinations. Primary outcomes measured were the progression of BPH symptoms, urinary function, and prostate size. Secondary outcomes included quality of life, acute urinary retention, the need for surgical intervention, medication efficacy, and long-term complications. Statistical analyses employed included Chi-square tests, t-tests, and ANOVA, with SPSS software. Results: The group with prostatic inflammation showed significantly more severe symptom progression (p &lt; 0.01), impaired urinary function (p &lt; 0.01), and increased prostate size (p &lt; 0.01) compared to the non-inflamed group. Secondary outcomes also favored the non-inflamed group with better quality of life scores (75.2 ± 5.2 vs. 78.8 ± 4.8, p &lt; 0.01), lower rates of acute urinary retention (20.3% vs. 15.5%, p &lt; 0.01). Conclusion: Prostatic inflammation significantly worsens the clinical outcomes of BPH, affecting symptom progression, treatment response, and the likelihood of long-term complications. These findings suggest the need for integrated therapeutic strategies that address both BPH and prostatic inflammation to optimize patient care.

Increased prostate volume on transrectal ultrasound and magnetic resonance imaging are potential risk factors for acute urinary retention following transperineal prostate biopsy.

308 Background: Prostate biopsy is one of the most frequently performed procedures in urology. Recently, there has been a nationwide shift towards offering transperineal (TP) biopsies due to a reduced rate of infectious complications compared to the transrectal (TR) route. While infection may be reduced, TP biopsy is not without complication, most notably, acute urinary retention (AUR). Estimates vary as to the true rate of AUR following TP biopsy. Further, some studies have reported higher rates of AUR following TP biopsy than TR. Here we report the rate of AUR following TP biopsy at a single academic institute and relate it to risk factors for developing AUR. Methods: Retrospective case-control study. All biopsies performed with TR ultrasound (TRUS) guidance using TP technique under general anesthesia in dorsal lithotomy with a grid template. TRUS volumes were recorded during the procedure, and MRI volumes were calculated by a trained radiologist pre-biopsy. Charts of men undergoing TP biopsy from 2012 to present were reviewed. AUR was defined as patients who reported inability to urinate within 72 hours post-biopsy and underwent thorough evaluation including PVR and relevant H&amp;P and required catheter placement. Independent samples t-test was run to relate AUR to risk factors pre/post-biopsy. Results: A total of 767 TP biopsies were completed in the study window, but not all had TRUS/MRI data. Total rate of AUR was 5.48% (N=42/767). Risk factors for AUR were increased TRUS (p=0.009, [6.49, 42.30]) and MRI prostate volumes (p=0.027, [2.90, 43.13]). Age, number of cores taken, and number of previous biopsies were not associated with AUR. Conclusions: While data is scant, the rate of AUR at our institution is consistent with current estimates in the literature. There is a growing body of evidence that the rate of AUR post-TP biopsy is higher than TR, but more investigation is needed. There is also a gap in the literature on risk factors predicting AUR after TP biopsy, however our findings are relatively consistent with the few studies currently published. Urologists must recognize patients presenting for TP biopsy with large volume prostates and consider altering management to prevent AUR. [Table: see text]

The Evaluation and Management of Acute Urinary Retention in Elderly Male patients

Background: Urinary retention is a common urologicalemergency characterized by sudden inability to pass urinedespite having a full bladder, which may or may not beassociated with abdominal pain.Objective: The aim of this retrospective study is to documentthe prevalence, risk factors, management and outcomes ofacute urinary retention in geriatric male patients.Materials and Methods: Medical records of all patients whohad acute urinary retention treated at Urology Center Khost,from January 2018 to April 2020 were retrospectively reviewed.A total of 181 patients who had acute urinary retention wereincluded in this study. The demographic information, etiologyand treatment methods were collected and analyzed.Results: The average age ranged from 47 to 89 years withmedian age of 73. A total of 68 out of 181 patients presentingwith acute urinary retention were previously diagnosed withBPH history of 1 year 15 patients (21%), 5 years 33 patients(48%), &gt;10 years 20 patients (31%). The rest of 113 patientswere categorized as having newly diagnosed BPH (54 cases)48%, urethral stricture owing to STD (4 cases) 3.5%, historyof penile trauma (2 cases) 1.7%, occlusion due to urethraland bladder stone (2 cases) 1.7%, bladder carcinoma (1case) 1%, neurologic disorder (stroke, spinal cord lesion anddiabetic neuropathy) 62 cases (53%), neurogenic bladder 7cases (6.2%). Urinary tract infection was exclusively foundin majority of the cases. Over all in 93% of the patients, thesymptoms resolved with successful bladder decompressionthrough urethral catheterization, 7% of the patients with difficultcatheterization, drainage was achieved by suprapubic bladdercatheterization under local anesthesia.Conclusions: This study suggests that the incidence rate ofacute urinary retention is directly related to the efforts madein primary prevention of acute urinary retention in high riskpatients. Acute urinary retention in BPH cases was moreevident in age group of ≥65 years. The most commonly usedinitial management for acute urinary retention was by carryingout bladder decompression via urethral catheterization, andsuprapubic catheter only being used in failures.

Immediate versus early (24-hours) urinary catheter removal after elective minimally invasive colonic resection: study protocol for a randomized, multicenter, non-inferiority trial

BackgroundEnhanced Recovery After Surgery (ERAS) represents the standard of care in colorectal surgery. Among ERAS items, early removal of urinary catheter (UC) is considered a key issue, though adherence to this specific item still varies among centers. UC placement allows for monitoring of post-operative urinary output but relates to an increased risk of urinary tract infection (UTI), reduced mobility, and patient’s discomfort. Several studies investigated the role of early UC removal specifically looking at the rate of acute urinary retention (AUR) but most of them were retrospective, single-center, underpowered, cohort studies. The main purpose of this study is to compare the rate of AUR after immediate (at the end of the surgery) versus early (within 24 h from the completion of surgery) removal of UC in patients undergoing minimally invasive colonic resection (MICR). The secondary outcomes focus on goals that could be positively impacted by the immediate removal of the UC at the end of the surgery. In particular, the rate of UTIs, perception of pain, time-to-return of bowel and physical functions, postoperative complications, and length of hospital stay will be measured.MethodsThis is a prospective, randomized, controlled, two-arm, multi-center, study comparing the rate of AUR after immediate versus early removal of UC in patients undergoing MICR. The investigators hypothesize that immediate UC removal is non-inferior to 24-h UC removal in terms of AUR rate. Randomization is at the patient level and participants are randomized 1:1 to remove their UC either immediately or within 24 h from the completion of surgery. Those eligible for inclusion were patients undergoing any MICR with an anastomosis above the peritoneal reflection. Those patients who need to continue urinary output monitoring after the surgery will be excluded. The number of patients calculated to be enrolled in each group is 108 based on an expected AUR rate of 3% for the 24-h UC removal group and considering acceptable an AUR of 9% for the immediate UC removal group.DiscussionThe demonstration of a non-inferiority of immediate versus 24-h removal of UC would call into question the usefulness of urinary drainage in the setting of MICR.Trial registrationClinicalTrials.gov NCT05249192. Prospectively registered on February 21, 2022.

Acute urinary retention in men: 21-year trends in incidence, subsequent benign prostatic hyperplasia-related treatment and mortality: A Danish population-based cohort study.

To examine trends in incidence of acute urinary retention, subsequent benign prostatic hyperplasia-related treatment and mortality in the era of medical therapy for benign prostatic hyperplasia. Additionally, to compare mortality with the general population. We conducted a Danish nationwide registry-based study including 70,775 men aged 45 years or older with a first hospitalization for acute urinary retention during 1997-2017. We computed annual standardized incidence rates, subsequent 1-year cumulative incidence of benign prostatic hyperplasia-related surgical and medical treatment, and standardized 3-month and 1-year mortality rates. Finally, we compared standardized all-cause and cause-specific mortality ratios with the general population. The standardized incidence rate of acute urinary retention per 1000 person-years increased transiently from 2.34 to 3.42 during 1997-2004, but gradually declined to 2.95 in 2017. The 1-year cumulative incidence of benign prostatic hyperplasia-related surgery declined from 31.2% to 19.8% and 20.5% to 7.7% after spontaneous and precipitated acute urinary retention, respectively. During 1997-2017, the standardized 1-year mortality declined from 22.2% to 17.2%. Compared with the general population, mortality was 4-5 times higher after 3 months and 2-3 times higher after 1 year of acute urinary retention. The cause-specific standardized mortality ratios were particularly high for deaths attributable to malignancies, urogenital disease, certain infections, chronic pulmonary disease, and diabetes. During 1997-2017, we observed a transient increase in the incidence of acute urinary retention. The subsequent use of benign prostatic hyperplasia-related surgery declined considerably and mortality continued to be high, mainly because of deaths from malignancies, urogenital disease, infections,and preexisting comorbidity.

The association between histological prostatitis and benign prostatic hyperplasia: a single-center retrospective study

Objective To investigate the relationship between histological prostatitis (HP) and clinical parameters related to benign prostatic hyperplasia (BPH) in male. Method The clinical data of 196 BPH patients who underwent transurethral resection of the prostate were collected. According to the results of hematoxylin-eosin (H&E) staining of prostate tissue, patients were divided into two groups: BPH with HP group and BPH without HP group. Differences in acute urinary retention (AUR), prostate volume (PV), serum sex hormones, lower urinary tract symptoms (LUTS) related parameters, and systemic inflammation indicators were compared between the two groups. SPSS software v.25 was used for statistical analysis. Results Compared with the BPH without HP group, the BPH with HP group had greater AUR rate, PV, total IPSS, and IPSS-storage in BPH with HP group (p < 0.05). However, there were no significant differences in IPSS-voiding, post-void residual volume, maximum urinary flow rate, serum sex hormones, and systemic inflammation indicators between the two groups (p > 0.05). Conclusions This study suggests that patients with HP have larger PV, more severe LUTS, and a higher risk of AUR. HP is closely related to BPH and may be a key factor in the occurrence and clinical progress of BPH.

Long-term outcomes of polyacrylamide hydrogel treatment in women with stress urinary incontinence.

Long-term outcomes of polyacrylamide hydrogel treatment in women with stress urinary incontinence.

MP15-16 VERY EARLY CATHETER REMOVAL ON POSTOPERATIVE DAY 2 AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY: REPORTING ON EARLY COMPLICATIONS AND FUNCTIONAL RESULTS

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy I (MP15)1 Sep 2021MP15-16 VERY EARLY CATHETER REMOVAL ON POSTOPERATIVE DAY 2 AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY: REPORTING ON EARLY COMPLICATIONS AND FUNCTIONAL RESULTS Dries Develtere, Giuseppe Rosiello, Pietro Piazza, Abhishek Pandey, Camille Berquin, Sinatti Celine, Hannah Van Puyvelde, Stefano Puliatti, Marco Amato, Rui Farhina, Elisabeth Pauwels, Ruben De Groote, Peter Schatteman, Geert De Naeyer, Frederiek D'Hondt, and Alexandre Mottrie Dries Develtere Dries Develtere More articles by this author , Giuseppe RosielloGiuseppe Rosiello More articles by this author , Pietro PiazzaPietro Piazza More articles by this author , Abhishek PandeyAbhishek Pandey More articles by this author , Camille BerquinCamille Berquin More articles by this author , Sinatti CelineSinatti Celine More articles by this author , Hannah Van PuyveldeHannah Van Puyvelde More articles by this author , Stefano PuliattiStefano Puliatti More articles by this author , Marco AmatoMarco Amato More articles by this author , Rui FarhinaRui Farhina More articles by this author , Elisabeth PauwelsElisabeth Pauwels More articles by this author , Ruben De GrooteRuben De Groote More articles by this author , Peter SchattemanPeter Schatteman More articles by this author , Geert De NaeyerGeert De Naeyer More articles by this author , Frederiek D'HondtFrederiek D'Hondt More articles by this author , and Alexandre MottrieAlexandre Mottrie More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001996.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Presence of an indwelling urinary catheter following robot-assisted radical prostatectomy (RARP) is reported as a significant bother. Moreover, it’s presence can lead to several catheter-related issues, with a significant burden on patients’ life. The current study aims to evaluate the feasibility of postoperative day (POD 2) catheter removal after RARP and to assess its impact on short- and long-term urinary continence (UC). METHODS: Patient characteristics and perioperative data were prospectively collected for 402 consecutive patients treated with RARP ± pelvic lymph node dissection (PLND) between January 2018 and July 2019. After exclusion, (locally advanced prostate cancer, missing follow-up data) final population consisted of 369 patients. Postoperative complications and UC were retrospectively analyzed. Ethical committee approval has been obtained. RESULTS: 255 (70%) patients underwent catheter removal on POD 2. 65 (25%) received PLND. 1 patient experienced a major postoperative complication [Clavien Dindo Classification (CDC) > IIIa]. 33 (12.9%) required re-catheterization due to acute urinary retention (AUR) after catheter removal (CDC I). 5 (2%) patients required re-catheterization due to AUR combined with anastomotic leakage. After a median follow-up of 18 months [Interquartile range (IQR) 13-24] 236 (93%) patients recovered UC. Early UC rate was 67% and median time to UC recovery was 1 month (IQR: 0-4). No anastomotic strictures were recorded. Age at surgery (p=0.1), prostate volume (p=0.6), and voiding LUTS (p=0.2) were not associated with the risk of retention after POD 2 catheter removal. CONCLUSIONS: Indwelling catheter removal on POD 2 after RARP is a safe option in patients with localized PCa, with acceptable rates of AUR and anastomotic leakage, and without impact on short- and long-term functional outcomes . Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e270-e270 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dries Develtere More articles by this author Giuseppe Rosiello More articles by this author Pietro Piazza More articles by this author Abhishek Pandey More articles by this author Camille Berquin More articles by this author Sinatti Celine More articles by this author Hannah Van Puyvelde More articles by this author Stefano Puliatti More articles by this author Marco Amato More articles by this author Rui Farhina More articles by this author Elisabeth Pauwels More articles by this author Ruben De Groote More articles by this author Peter Schatteman More articles by this author Geert De Naeyer More articles by this author Frederiek D'Hondt More articles by this author Alexandre Mottrie More articles by this author Expand All Advertisement Loading ...

Acute urinary retention rates following early removal or no placement in colon and rectal surgery: a single-center analysis.

The adequate duration of urinary drainage following colorectal surgery remains debated. The purpose of this study was to compare acute urinary retention (AUR) rates among various durations of urinary catheterization following colon and rectal surgery. We conducted a retrospective analysis of patients undergoing elective colorectal resection enrolled in the Enhanced Recovery After Surgery (ERAS) protocol from 2018 to 2019. Patients were placed into four groups: no catheter placement (NC), catheter removed immediately after surgery (CRAS), removal less than 24h (CR < 24), and removal greater than 24h (CR > 24). Our primary endpoint was the rate of AUR in each group. Secondary endpoints included hospital length of stay and urinary tract infections (UTI). A multivariate logistic regression analysis was done to predict AUR. A total 641 patients were included in this study. 27 patients (4.2%) had NC with an AUR rate of 3.7%. 249 patients (38.8%) had CRAS with an AUR rate of 6.8%. 214 patients (33.4%) had CR < 24 with an AUR rate of 4.2%. 151 patients (23.6%) had CR > 24 with an AUR rate of 2.6%. There was no significant difference in AUR among the groups (p = 0.264). In our multivariant logistic regression, pelvic surgery was an independent risk factor for AUR (p = 0.008). There was a statistically significant higher hospital length of stay (p = 0.001) and rate of UTIs (p = 0.017) in patients with prolonged catheterization. Deferral or early removal of urinary catheters is safe and feasible following colorectal surgery without a significant increase in AUR. Avoiding prolonged indwelling urinary catheterization may decrease associated complications such as UTI and hospital length of stay.

Safety and side effects of transperineal prostate biopsy without antibiotic prophylaxis

Study aimsTo investigate safety and side effects of transperineal prostate biopsy without antibiotic prophylaxis. Secondary aim was to identify whether the number of cores influenced the occurrence of complications. Patients and methodsA cohort of 184 patients undergoing perineal prostate biopsy without antibiotic prophylaxis from 2015 to 2017 was analyzed retrospectively. On average, 41 cores were taken via two perineal skin punctures. Demographic and clinical data were obtained from patients´ electronic medical records. Binary logistic regression was performed to identify predictors for complications with the following covariates: age, prostate specific antigen (PSA), prostate volume, Prostate Imaging Reporting and Data System score, history of prostatitis, therapeutic anticoagulation, risk factors for urinary tract infection, surgery duration, and the number of biopsy cores. Furthermore, we calculated chi-squared tests with post hoc analyses for differences in the occurrence of complications between quartiles of the above-mentioned parameters. ResultsThe overall complication rate was 10.8% (20/185). Out of 20, 19 (95 %) complications were ≤ grade 2 according to the Clavien-Dindo classification. There were two cases of afebrile urinary tract infection, and no patient developed fever or sepsis. Acute urinary retention was reported in 10 patients (5.4 %). The total number of cores was not associated to infectious complications or acute urinary retention rates. ConclusionsTransperineal prostate biopsy without antibiotic prophylaxis is a safe procedure. Neither postoperative fever nor sepsis occurred. An increased number of cores through two skin punctures was not associated with more complications.

Retrospective analysis of the changes in the surgical treatment of benign prostatic hyperplasia during an 11-year period: a single-center experience.

The present study aimed to determine whether the number of patients with symptomatic benign prostatic hyperplasia (BPH) who preferred surgery decreased during the past 11 years at our center (West China Hospital, Chengdu, China), and whether this change affected the timing of surgery and the physical condition of surgical patients. This retrospective study included 57 557 patients with BPH treated from January 2008 to December 2018. Of these, 5427 patients were treated surgically. Surgical patients were divided into two groups based on the time of treatment (groups 8–13 and groups 13–18). The collected data comprised the percentage of all patients with BPH who underwent surgery, baseline characteristics of surgical patients, rehabilitation time, adverse events, and hospitalization costs. The surgery rates in groups 8–13 and groups 13–18 were 10.5% and 8.5% (P < 0.001), respectively. The two groups did not clinically differ regarding patient age and prostate volume. The rates of acute urinary retention and renal failure decreased from 15.0% to 10.6% (P < 0.001) and from 5.2% to 3.1% (P < 0.001), respectively. In groups 8–13 and groups 13–18, the mean catheterization times were 4.0 ± 1.7 days and 3.3 ± 1.6 days (P < 0.001), respectively, and the mean postoperative hospitalization times were 5.1 ± 2.4 days and 4.2 ± 1.8 days (P < 0.001), respectively. The incidences of unplanned second surgery and death reduced during the study period. The surgery rate decreased over time, which suggests that medication was chosen over surgery. However, the percentage of late complications of BPH also decreased over time, which indicates that the timing of surgery was not delayed.

MP75-07 A TERRITORY-WIDE STUDY ON THE PREDICTORS OF 30-DAY COMPLICATIONS IN TRANSRECTAL VERSUS TRANSPERINEAL PROSTATE BIOPSY

INTRODUCTION AND OBJECTIVE: As the "trexit" initiative continues to gain popularity around the world, we aimed to conduct a territory-wide study to investigate the complications rates of transrectal (TR) versus transperineal (TP) prostate biopsy, and to investigate for predictors of complications. METHODS: All data were extracted from a territory-wide electronic patient record system, which records details of every emergency attendance and hospital admission in all public hospitals in Hong Kong. Consecutive patients with transrectal or transperineal prostate biopsies performed in all public hospitals in Hong Kong from January 2016 to October 2019 were included. Baseline characteristics including age, PSA level, diabetes, and drug use (alpha-blockers, anti-cholinergic, antiplatelet, and anti-coagulants) were recorded. 30-day complications requiring emergency attendance or hospital admission, including per-rectal bleeding, hematuria, acute urinary retention, urine culture proven urinary tract infection (UTI), and blood culture proven sepsis were recorded. Multivariate logistic regression analyses were performed to investigate for predictors of complications. RESULTS: The cohort included 9918 TR prostate biopsy and 1001 TP prostate biopsy patients. The TP group had a higher PSA level (67.2±402.6ng/mL vs 54.8±373.8ng/mL, p<0.001) and higher proportion of diabetes (12.9% vs 10.8%, p<0.001). The TR group had higher rates of per-rectal bleeding (0.6% vs 0%, p=0.015), urine culture proven UTI (3.3% vs 1.7%, p=0.007) and blood culture proven sepsis (1.5% vs 0.3%, p=0.002). The TP group had a higher rate of acute urinary retention (5.3% vs 3.2%, p<0.001). The overall complication rates were similar between the TR and TP groups (8.3% vs 8.1%, p=0.805). Multivariate analysis showed that TP biopsy was a significant protective factor for UTI (OR 0.57, 95%CI 0.35-0.93, p=0.025) and sepsis (OR 0.23, 95% CI 0.07-0.72, p=0.012). TP biopsy was a significant risk factor for acute urinary retention (OR 1.81, 95%CI 1.32-2.47, p<0.001). Prior use of alpha-blocker was a significant risk factor of per-rectal bleeding (OR 1.96, 95%CI 1.08-3.56, p=0.028), acute urinary retention (OR 2.72, 95%CI 2.15-3.43, p<0.001) and overall complications (OR 1.71, 95%CI 1.45-2.01, p<0.001). CONCLUSIONS: Transperineal approach could reduce post-biopsy UTI and sepsis. However, our results suggested a higher rate of acute urinary retention especially in TP patients with pre-existing benign prostatic obstruction requiring use of alpha-blockers. Source of Funding: nil

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.

Optimal timing of urinary catheter removal following pelvic colorectal surgery: a systematic review and meta-analysis.

Acute urinary retention (AUR) is a common postoperative complication in colorectal surgery. In pelvic colorectal operations, the optimal duration for postoperative urinary catheter use is controversial. This systematic review and meta-analysis aims to compare early (POD 1), intermediate (POD 3), and late (POD 5) urinary catheter removal. Medline, EMBASE, CENTRAL, and PubMed databases were searched. Articles were eligible for inclusion if they compared patients with urinary catheter removal on POD 1 or earlier to patients with urinary catheter removal on POD 2 or later in major pelvic colorectal surgeries. The primary outcome was rate of postoperative AUR. The secondary outcome was rates of postoperative urinary tract infection (UTI). From 691 relevant citations, five studies with 928 patients were included. Comparison of urinary catheter removal on POD 1 versus POD 3 demonstrated no significant difference in rate of urinary retention (RR 1.36, 95%CI 0.83-2.21, P = 0.22); however, compared to POD 5, rates of AUR were significantly higher (RR 2.58, 95%CI 1.51-4.40, P = 0.0005). Rates of UTI were not significantly different between POD 1 and POD 3 urinary catheter removal (RR 0.40, 95%CI 0.05-3.71, P = 0.45), but removal on POD 5 significantly increased risk of UTI compared to POD 1 (RR 0.50, 95%CI 0.31-0.81, P = 0.005). Risk of AUR can be minimized with late postoperative urinary catheter removal compared to early removal, but at the cost of increased risk of UTI. Patient-specific factors should be taken into consideration when deciding upon optimal duration of postoperative urinary catheterization.

Preoperative multiparametric prostate magnetic resonance imaging: a safe clinical practice to reduce incidental prostate cancer in Holmium laser enucleation of the prostate

IntroductionPurpose of the study was to investigate the correlation of a preoperative multiparametric magnetic resonance imaging of the prostate (mpMRI) in patients with a suspicion of prostate cancer and eligible for Holmium Laser Enucleation of the Prostate (HoLEP).Material and methodsData of 228 patients who had undergone HoLEP was selected and retrospectively analyzed from a multicentric database. All patients presented with a raised serum PSA and/or an abnormal digital rectal examination (DRE). Prostate cancer (PCa) was excluded either with a negative mpMRI (group ‘NEGATIVE MRI’ n = 113) or a standard biopsy (group ‘NO MRI’ n = 115). Preoperative characteristic surgical and histological outcomes were confronted. A univariate and multivariate logistic regression model was performed to investigate independent predictors of incidental Prostate Cancer (iPCa).ResultsBoth groups presented with no statistical differences in preoperative characteristics besides previous acute urinary retention rates and post-voided residual volume, found to be higher (27.8% vs. 14.2% and median 120cc vs. 80cc) in NO MRI and NEGATIVE MRI respectively.No differences were registered in surgical time, removed tissue, catheterization time, hospital stay and complications rate.Statistically lower rate of iPCa (p = 0.03) was detected in the NEGATIVE MRI group (6.2%) in comparison with NO MRI group (14.8%). In multivariate logistic regression only presence of a preoperative negative mpMRI correlated (p = 0.04) as an independent predictive factor (OR 2.63; 95% CI: 1.02–6.75).ConclusionsA negative mpMRI might be a useful tool to be included in a novel preoperative assessment to patients eligible for HoLEP with a suspicion of PCa in order to avoid an incidental PCa.

Robot-assisted Partial Nephrectomy: Is Routine Urinary Catheterization Still Mandatory in the Era of Enhanced Recovery?

ObjectiveTo assess the benefits and safety of noncatheterization during robot-assisted partial nephrectomy within an enhanced recovery protocol. Materials and MethodsA single-center retrospective comparative study was carried out of consecutive patients who underwent a robot-assisted partial nephrectomy between February 2015 and December 2017 within an early recovery program. The patients who received a urinary catheter were compared with those who did not in terms of postoperative complications, acute urinary retention rates, urinary tract infection rates, and lengths of hospital stay. ResultsOf the 145 patients who followed an early recovery program after robot-assisted partial nephrectomy in the study period, 96 received a urinary catheter and 49 did not. There was no significant difference between these 2 groups in terms of the rates of acute urinary retention (3% vs 6%, respectively; P = .393), urinary tract infection (3% vs 2%; P = .707), postoperative complications (14% vs 18%; P = .445), or readmissions within 30 days (8% vs 6%; P = .636). However, patients who did not receive a catheter had shorter initial and total (including readmissions) lengths of hospital stay (respectively 2.16 days vs 2.56 days; P = .058, and 2.27 days vs 3.40 days; P <.001). ConclusionOur findings challenge the routine use of urinary catheterization during robot-assisted partial nephrectomies. Noncatheterization does not seem to increase the risk of postoperative urinary retention. Only catheterizing specific at-risk patients may prove beneficial.