A prospective pilot study to validate the management protocol for patients presenting with acute urinary retention: a community-based, nonhospitalised protocol.

Abstract

Acute urinary retention (AUR) in males is managed conventionally by hospital admission, alpha-adrenergic therapy, and trial without catheter. To reduce inpatient bed pressures, we set up a protocol to manage such patients in the community. We review our results in this paper. We performed a prospective study of male patients presenting to our acute admissions ward and Accident and Emergency department over 6 months. Patients with chronic urinary retention, macroscopic haematuria, sepsis, urinary tract infection, and/or serum creatinine >130 mmol/l were excluded from the study. Those enrolled were catheterised, commenced on alfuzosin (10 mg nocte), and discharged to the community. A trial without catheter (TWOC) was performed 5-7 days later. QoL/IPSS, peak flow rate, and residual volume assessment were performed following successful TWOC 3 months later. Thirty-one male patients with a median age of 69 years were studied and the median residual volume following catheterisation was 900 ml. The aetiology of AUR was benign prostatic hyperplasia (BPH) in 29 patients and constipation in the remaining 2 patients. TWOC was successful in 19 patients (61.3%) following first TWOC, 26 (83.9%) following second trial of voiding. The mean peak flow rate was 6.5 ml/sec and postvoid scan 165 ml, following an immediate TWOC. At 3 months follow-up, mean peak flow rate was 13.2 ml/sec, postvoid scan 26.5 ml, IPSS 4.5, and QoL score was 2. This study has shown that AUR can be managed safely and effectively in the community. Effective communication with the nurse urology specialist, general practitioner, and emergency department are crucial for the successful implementation of the protocol.