The Role of Urodynamics Study in Prediction of Short Term Outcome of Prostatectomy in Patients with Chronic Urinary Retention (original) (raw)
Related papers
The management of men with acute urinary retention
Bju International, 1998
Objectives To determine the outcome of men with acute were older, had larger glands and had more comorbidity, these factors did not totally explain the excess risk. urinary retention undergoing prostatectomy and to assess whether discharge with a catheter before sub-The final symptomatic outcome of men with acute retention was no diCerent from that of men presenting sequent planned re-admission for prostatectomy had an adverse eCect on outcome. for elective treatment. Men with retention who were managed by initial catheterization, sent home and Patients and methods A prospective cohort study was conducted of all men undergoing prostatectomy in subsequently re-admitted for planned operation had similar pretreatment characteristics, post-operative five health care regions over a 6-month period in 56 hospitals where prostatectomies were performed under complications and outcomes to those who were kept in hospital throughout, although the men kept in the care of 103 surgeons. The study included 3966 men undergoing prostatectomy, of whom 1242 pre-hospital had a total increased length of stay. Conclusions Men with acute retention have a high risk sented with acute urinary retention; the complication rates and symptomatic outcome were assessed. of developing complications after undergoing prostatectomy. We were unable to confirm that a short-Results Compared with those who underwent elective prostatectomy for symptoms alone, men presenting term period of catheter drainage at home before re-admission for planned surgery carried increased with acute retention had an excess risk of death at 30 days (relative risk [RR], 26.6, 95% confidence interval risks of peri-operative complications. Keywords Retention, prostatectomy, benign prostatic [CI], 3.5-204.5) and at 90 days after operation (RR 4.4, 95% CI 2.5-7.6), and an increased risk of peri-hyperplasia, morbidity operative complications. Although men with retention operation might have an adverse eCect on peri-operative
Prostate size influences the outcome after presenting with acute urinary retention
Bju International, 2004
The relevance of prostatic size to treatment outcome has been stressed by many authors, in terms of likelihood of response to 5α-reductase inhibitors and as a risk factor for future surgery or acute urinary retention. Authors from Scotland studied patients who developed acute retention and were treated with catheter removal and α-adrenergic blockage. They found that, in this group of patients, prostate size was the key determinant as to whether surgery would be required or whether the more conservative treatment would be successful.The relevance of prostatic size to treatment outcome has been stressed by many authors, in terms of likelihood of response to 5α-reductase inhibitors and as a risk factor for future surgery or acute urinary retention. Authors from Scotland studied patients who developed acute retention and were treated with catheter removal and α-adrenergic blockage. They found that, in this group of patients, prostate size was the key determinant as to whether surgery would be required or whether the more conservative treatment would be successful.OBJECTIVETo evaluate the long-term outcome in an open follow-up of a cohort of patients who had had a successful trial without catheter (TWOC) after an episode of acute urinary retention (AUR), as it is now widely accepted that giving an α-blocker, e.g. alfuzosin, increases the success rate of TWOC.To evaluate the long-term outcome in an open follow-up of a cohort of patients who had had a successful trial without catheter (TWOC) after an episode of acute urinary retention (AUR), as it is now widely accepted that giving an α-blocker, e.g. alfuzosin, increases the success rate of TWOC.PATIENTS AND METHODSIn this prospective trial, 81 patients with a first episode of AUR related to benign prostatic obstruction received either sustained-release alfuzosin (40) 5 mg twice daily or placebo (41) for 48 h. The catheter was removed after 24 h of treatment and the patient's ability to void assessed. Those who voided successfully entered an open follow-up, the defined endpoints of which were the date of recurrent AUR, date of bladder outlet surgery, date of last follow-up or death, and factors that influenced the long-term outcome after a successful TWOC were examined.In this prospective trial, 81 patients with a first episode of AUR related to benign prostatic obstruction received either sustained-release alfuzosin (40) 5 mg twice daily or placebo (41) for 48 h. The catheter was removed after 24 h of treatment and the patient's ability to void assessed. Those who voided successfully entered an open follow-up, the defined endpoints of which were the date of recurrent AUR, date of bladder outlet surgery, date of last follow-up or death, and factors that influenced the long-term outcome after a successful TWOC were examined.RESULTSOf the 34 patients who had a successful TWOC (22 on alfuzosin, 12 placebo, P= 0.03), 21 continued on an α-blocker at the discretion of their urologist. In all, 26 had a further episode of AUR or surgery during the 6-year follow-up. The mean (median, range) time to the second episode of AUR in the 20 (59%) patients affected was 1.4 (0.6, 0–5.95) years. Nineteen (56%) men had bladder outlet surgery, 13 after a second episode of AUR. The mean time to operation after the first AUR was 1.85 (1.1, 0.04–5.4) years. The remaining eight (24%) patients remained free of further AUR and surgery. The size of the prostate assessed on a digital rectal examination by the admitting urologist was the only factor with a significant effect on the long-term outcome. A postvoid residual of > 50 mL was associated with a greater likelihood of recurrent AUR or surgery, but this was not statistically significant.Of the 34 patients who had a successful TWOC (22 on alfuzosin, 12 placebo, P= 0.03), 21 continued on an α-blocker at the discretion of their urologist. In all, 26 had a further episode of AUR or surgery during the 6-year follow-up. The mean (median, range) time to the second episode of AUR in the 20 (59%) patients affected was 1.4 (0.6, 0–5.95) years. Nineteen (56%) men had bladder outlet surgery, 13 after a second episode of AUR. The mean time to operation after the first AUR was 1.85 (1.1, 0.04–5.4) years. The remaining eight (24%) patients remained free of further AUR and surgery. The size of the prostate assessed on a digital rectal examination by the admitting urologist was the only factor with a significant effect on the long-term outcome. A postvoid residual of > 50 mL was associated with a greater likelihood of recurrent AUR or surgery, but this was not statistically significant.CONCLUSIONSThis study provides further evidence of the importance of prostate size as a prognostic factor in determining the outcome in patients with prostatic obstruction. Whilst most men presenting with AUR will eventually have prostatic surgery, a significant minority will not. An assessment of risk factors such as prostate size may identify those who require urgent intervention after a successful TWOC. The role of continued medical therapy with α-blockers and/or 5α-reductase inhibitors after a successful TWOC merits further investigation.This study provides further evidence of the importance of prostate size as a prognostic factor in determining the outcome in patients with prostatic obstruction. Whilst most men presenting with AUR will eventually have prostatic surgery, a significant minority will not. An assessment of risk factors such as prostate size may identify those who require urgent intervention after a successful TWOC. The role of continued medical therapy with α-blockers and/or 5α-reductase inhibitors after a successful TWOC merits further investigation.
Management of Lower Urinary Retention in a Limited Resource Setting
Ethiopian Journal of Health Sciences, 2014
BACKGROUND: There is a projected increase in lower urinary tract obstruction by 2018, especially in the developing economies of Asia and Africa. However in many of these countries, the problems encountered both by the patients and the clinicians are not well documented. Our aims are, to prospectively analyse the management of urinary retention, the associated difficulties, and complications in our setting, where access to investigative modalities such as Computerize Tomography and Magnetic Resonance Imaging are not available. PATIENTS AND METHODS: The study was approved by the University Of Calabar Teaching Hospital ethical committee. A validated Proforma was used to collect data from all patients who were clinically diagnosed with urinary retention based on history, and physical examination, from July 2009 to June 2010. Data collected from the 1st of July 2009 to the 30th of June 2010, include demographics, findings on physical examination, previous medical history and co-morbid conditions. The results of investigations done such as: urinalysis, full blood count, electrolytes, urea and creatinine, intravenous urography, trans-abdominal ultrasonography, chest X-ray and histology of trans-rectal biopsies of the prostate. The total number of new patients seen, including those with urinary retention during the study was documented. The retentions were also classified into acute and chronic. All the patients were followed up throughout the study. The data was analysed using Epi-Info statistical program version 3.4 of 2007 to analyse the data, estimating averages, mean, median and percentages. RESULTS: The total number of new patients seen, including those with urinary retention was Seventy thousand, one hundred and thirty nine (70,139).Of this number, hundred and fifty nine (0.23%), presented with urinary retention; 145 (91.2%) were acute, and14 (8.8%) were chronic. The male: female ratio was 39:1.The patients ages ranged from 4 to 94 years, with a mean of 53.7±11.2. Seventy seven [48.4%] of them were in the 6 th and 7 th decades of life. The common causes were; prostatic diseases [BPH and cancer of the prostate] 77.0%, infections 75.8%, trauma 12.1%, and congenital 12.1%. Urinary retention was relieved by: indwelling urethral catheterization [IUC] 120 patients (75.5%), supra-pubic cystostomy [SC] 34 (21.4%) and intermittent urethral catheterization [IC] 5 (3.1%). The most frequently encountered complications include pyuria (18.2%), pericatheter sepsis 17.5%, and haemorrhage during change of catheter 16.8% [figure 2]. CONCLUSION: Lower urinary retention is common in our environment. The management is appropriate and standard. The man power and facilities are inadequate, and requires urgent improvement.
Journal of King Abdulaziz University - Medical Sciences, 2016
A cohort study from January 2000 till January 2005 included all patients who underwent prostatic surgery with histopathology report of benign prostatic hyperplasia. Patients were divided into elective or retention group. Data of patient demographics, satisfaction and postoperative complications were collected. Total of 119 patients, retention (n = 30), elective group (n = 89). Retention rate was 25%. There was no eff ect of retention on postoperative complication (elective = 44%, retention = 41%) p value = 0.826, odds ratio 0.878, CI (0.363 - 2.124) nor any eff ect on patients' satisfaction (elective = 54%, retention = 59%) p value = 0.661, odds ration = 1.256, CI (0.520 - 3.034). Patients’ age and prostate size did not show any effect on postoperative outcome. While presence of infl ammatory cells in benign prostatic hyperplasia (BPH) histopathology showed positiveeff ect on satisfaction (BPH alone = 47%, BPH + infl ammation = 71%) p value = 0.037, and a protective eff ect on p...
The Effect of Prostatectomy on Urodynamic Parameters
British Journal of Urology, 1979
Sixty per cent of men subjected to prostatectomy had unstable bladders. It was found that this was related to the presence of either an indwelling catheter or obstruction, but had little influence on the result of prostatectomy. The functional urethral pressure profile length did not correlate with the size of the prostate gland. Shortening of the prostatic plateau was always found, but the extent to which the plateau was reduced did not correlate with urine flow rates.
Northern Clinics of Istanbul
OBJECTIVE: Postoperative urinary retention (POUR) is a common complication after spinal anesthesia. Ultrasound (US) is a simple, non-invasive method to estimate bladder volume before and after surgery. Primary aim of the present study was to investigate utility of bladder volume measured before and after surgery in prediction of POUR risk. Secondary aim was to investigate necessity of urethral catheter use and risk of urethral catheter-related infections. METHODS: Eighty patients who received spinal anesthesia for arthroscopic knee surgery were included in the study. Level and duration of sensory and motor block; bladder volume measured preoperatively, in post-anesthetic care unit (PACU), and when discharged from PACU; use of urethral catheter; and incidence of urinary tract infection data were recorded. RESULTS: POUR was observed in 28.7% of patients. Length of time for sensory block regression was significantly shorter in patients without POUR (p=0.012). Spontaneous urination was not observed in 3 of 23 patients with POUR, although bladder volume was less than 600 mL. Bladder volume over 600 mL without urination was recorded in 20 patients. There was no statistical difference in preoperative bladder volume between patients who did or did not develop POUR. Bladder volume on admission to PACU was higher in patients with POUR (p=0.023). Urgency and dysuria were observed in 5 patients who required urethral catheterization during postoperative period. Urinary tract infection developed in 1 patient. There was no statistical difference in development of urinary tract infection between patient groups who did and did not undergo urethral catheterization. CONCLUSION: Assessment of patient bladder volume with US before arthroscopic knee surgery may be used to foresee development of POUR. Avoiding elective urinary catheterization may reduce urinary infections.