McNeill Alan S, Rizvi Syed, Byrne Derek J
Department of Urology, Western General Hospital, Edinburgh, Scotland, UK.
BJU Int. 2004 Sep;94(4):559-62. doi: 10.1111/j.1464-410X.2004.05000.x.
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 alpha-blocker, e.g. alfuzosin, increases the success rate of TWOC.
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.
Of the 34 patients who had a successful TWOC (22 on alfuzosin, 12 placebo, P= 0.03), 21 continued on an alpha-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.
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 alpha-blockers and/or 5alpha-reductase inhibitors after a successful TWOC merits further investigation.
评估一组急性尿潴留（AUR）发作后无导尿管试验（TWOC）成功的患者进行开放随访的长期结果，因为目前普遍认为给予α受体阻滞剂（如阿夫唑嗪）可提高TWOC的成功率。
在这项前瞻性试验中，81例与良性前列腺梗阻相关的首次AUR发作患者接受了持续释放阿夫唑嗪（40例，每日两次，每次5mg）或安慰剂（41例）治疗48小时。治疗24小时后拔除导尿管，并评估患者的排尿能力。成功排尿的患者进入开放随访，其定义的终点为复发性AUR的日期、膀胱出口手术的日期、最后一次随访或死亡的日期，并检查影响TWOC成功后长期结果的因素。
在34例TWOC成功的患者中（22例使用阿夫唑嗪，12例使用安慰剂，P = 0.03），21例根据泌尿科医生的判断继续使用α受体阻滞剂。在6年的随访期间，共有26例患者再次出现AUR或接受了手术。20例（59%）受影响患者中第二次AUR发作的平均（中位数，范围）时间为1.4（0.6，0 - 5.95）年。19例（56%）男性接受了膀胱出口手术，其中13例是在第二次AUR发作后。首次AUR发作后至手术的平均时间为1.85（1.1，0.04 - 5.4）年。其余8例（24%）患者未再出现AUR及接受手术。入院泌尿科医生通过直肠指检评估的前列腺大小是对长期结果有显著影响的唯一因素。排尿后残余尿量>50 mL与复发性AUR或手术的可能性增加相关，但这在统计学上无显著意义。
本研究进一步证明了前列腺大小作为预测前列腺梗阻患者预后的因素的重要性。虽然大多数出现AUR的男性最终将接受前列腺手术，但仍有相当少数患者不会。对前列腺大小等危险因素的评估可能有助于识别TWOC成功后需要紧急干预的患者。TWOC成功后继续使用α受体阻滞剂和/或5α还原酶抑制剂进行药物治疗的作用值得进一步研究。
