The management of acute urinary retention in France: a cross-sectional survey in 2618 men with benign prostatic hyperplasia

Objective To evaluate current practice in the management of acute urinary retention (AUR) in men with benign prostatic hyperplasia (BPH) in France. Patients and Methods In all, 2618 men (median age 72 years) presenting with non-febrile AUR were enrolled by 658 French urologists in a prospective cross-sectional survey. The patients' demography, history of BPH, type of AUR and its management (trial without catheter, TWOC, use of alpha(1)-blockers, immediate or elective surgery, other alternatives) were collected. Results Of the 2618 men analysed, 1875 (71.6%) had spontaneous AUR (sAUR) and 743 (28.4%) had precipitated AUR (pAUR), mainly after surgery with locoregional or general anaesthesia. BPH was revealed by AUR in 52.3% of men with pAUR and 25.9% of men with sAUR. A urethral catheter was inserted in most cases (82.7%) while only 16.7% had a suprapubic catheter. After initial catheterization, 72.8% of men had a TWOC (pAUR 89.4%, sAUR 66.2%, P < 0.001) after a median of 3 days of catheterization, 17.9% had elective surgery after a median of 8 days of catheterization (pAUR 7.1%, sAUR 22.1%, P < 0.001), 5.7% had immediate surgery after a median of 4 days of catheterization (pAUR 1.1%, sAUR 7.5%, P < 0.001), 0.4% had a urethral stent inserted and 1.1% had an indwelling catheter. Of the 1906 men who had a TWOC, 79% received an alpha(1)-blocker (mainly alfuzosin) before catheter removal. The TWOC was successful in 50.2% of men (pAUR 52.3%, sAUR, 49.0%, P = 0.17) and the success rate was significantly higher in men receiving an alpha(1)-blocker (53.0% vs 39.6%, P < 0.001) before the TWOC. If the TWOC failed, 33.4% had a second TWOC (pAUR 39.9%, sAUR 30.2%, P = 0.003) after a median of 7 days re-catheterization, 57.5% had elective surgery (pAUR 49.1%, sAUR, 61.7%, P < 0.001) after a median of 8 days re-catheterization, 1.5% had a stent inserted and 1.1% had an indwelling catheter. The overall success rate of a second TWOC was 25.9% (pAUR 32.2%, sAUR 21.9%, P = 0.04). Men catheterized for > 3 days had a slightly lower success rate for TWOC, greater comorbidity and double the rate of prolonged hospitalization due to adverse events than those catheterized for <= 3 days. Conclusions TWOC after a median of 3 days of catheterization has become standard practice in France for men with BPH and AUR. alpha(1)-blockade before a TWOC significantly increases the chance of a successful TWOC. If the TWOC fails, only a quarter of men will have a successful second TWOC. All efforts should be made to reduce the duration of catheterization, to reduce the comorbidity.