Predictive factors for the success of trial without catheter for men with urinary retention

IF 1.5 4区医学 Q3 UROLOGY & NEPHROLOGY LUTS: Lower Urinary Tract Symptoms Pub Date : 2023-06-05 DOI:10.1111/luts.12492

Masato Takanashi, Hiroki Ito, Takeshi Fukazawa, Hiroki Takizawa, Mari Hioki, Risa Shinoki, Takashi Kawahara, Kazuki Kobayashi

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Abstract

Objective

To investigate the trial of spontaneous urination without catheter (TWOC) outcomes for men with acute urinary retention, determine successful TWOC predictors, and evaluate the impact of add-on medication therapy on TWOC.

Methods

This retrospective study included men with acute urinary retention and post-void residual (PVR) >250 mL who underwent TWOC between July 2009 and July 2019. Patients were divided into a medicated group who received alpha1 blocker on urinary retention diagnosis and a naïve group who did not. The trial was defined as unsuccessful if the PVR was >150 mL or if the patient experienced difficulty emptying their bladder with abdominal discomfort or pain, and a transurethral catheter was reinserted.

Results

Among 576 men with urinary retention, 269 (46.7%) constituted the medicated group and 307 (53.3%) the naïve. The naïve group comprised more elderly patients (P = 0.010) with higher Eastern Cooperative Oncology Group performance status (PS) (P = 0.001) and smaller prostate volume (P = 0.028) than the other. In the medicated group, 153 men received additional oral medication before TWOC to increase the success rate. There were significant age differences (P = 0.041) in the medicated group and significant median PS differences (P = 0.010) in the naïve group between the successful and unsuccessful outcomes of TWOC. The multivariate logistic regression model demonstrated that age <80 years in medicated patients (P = 0.042, odds ratio [OR] 1.701) and PS <2 in naïve patients (P = 0.001, OR 2.710) were significant independent predictors of successful TWOC outcomes.

Conclusions

This is the first study classifying patients with urinary retention according to medication status. Both medicated and naïve groups had different patient backgrounds and TWOC outcome predictors, suggesting a discrepant etiology behind urinary retention. Hence, acute urinary retention management in men should vary based on medication status for male lower urinary tract symptoms when urinary retention is diagnosed.

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男性尿潴留无导尿管试验成功的预测因素

目的探讨男性急性尿潴留患者无导管自然排尿(TWOC)结局的临床试验，确定成功的TWOC预测因素，并评估附加药物治疗对TWOC的影响。方法回顾性研究2009年7月至2019年7月期间接受TWOC治疗的急性尿潴留和膀胱后残留(PVR) >250 mL的男性患者。患者被分为两组，一组在尿潴留诊断时使用α 1阻滞剂，另一组不使用naïve。如果PVR为150 mL，或者患者因腹部不适或疼痛而排尿困难，则重新插入经尿道导管，则试验被定义为不成功。结果576例尿潴留患者中，给药组269例(46.7%)，naïve组307例(53.3%)。naïve组老年患者较多(P = 0.010)，东部肿瘤合作组表现状态(PS)较高(P = 0.001)，前列腺体积较小(P = 0.028)。在药物组中，153名男性在TWOC前接受了额外的口服药物以提高成功率。治疗组与不治疗组的年龄差异有统计学意义(P = 0.041)， naïve组的中位PS差异有统计学意义(P = 0.010)。多因素logistic回归模型显示，用药患者的年龄<80岁(P = 0.042，比值比[OR] 1.701)和naïve患者的年龄<2岁(P = 0.001, OR 2.710)是TWOC成功结局的显著独立预测因子。结论根据用药情况对尿潴留患者进行分类的研究尚属首次。药物组和naïve组都有不同的患者背景和TWOC结果预测因子，提示尿潴留背后的病因不同。因此，男性急性尿潴留的处理应根据诊断出尿潴留时男性下尿路症状的药物状况而有所不同。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

LUTS: Lower Urinary Tract Symptoms UROLOGY & NEPHROLOGY-

CiteScore

3.00

自引率

7.70%

发文量

审稿时长

>12 weeks

期刊介绍： LUTS is designed for the timely communication of peer-reviewed studies which provides new clinical and basic science information to physicians and researchers in the field of neurourology, urodynamics and urogynecology. Contributions are reviewed and selected by a group of distinguished referees from around the world, some of whom constitute the journal''s Editorial Board. The journal covers both basic and clinical research on lower urinary tract dysfunctions (LUTD), such as overactive bladder (OAB), detrusor underactivity, benign prostatic hyperplasia (BPH), bladder outlet obstruction (BOO), urinary incontinence, pelvic organ prolapse (POP), painful bladder syndrome (PBS), as well as on other relevant conditions. Case reports are published only if new findings are provided. LUTS is an official journal of the Japanese Continence Society, the Korean Continence Society, and the Taiwanese Continence Society. Submission of papers from all countries are welcome. LUTS has been accepted into Science Citation Index Expanded (SCIE) with a 2011 Impact Factor.