Mariappan Paramananthan, Brown David J G, McNeill Alan S
Department of Urology, Western General Hospital, Edinburgh, United Kingdom.
J Urol. 2007 Aug;178(2):573-7; discussion 577. doi: 10.1016/j.juro.2007.03.116. Epub 2007 Jun 14.
Trial without catheter after a short course of an alpha-blocker in men presenting with acute urinary retention is successful in up to 50% of cases. The ability to better predict outcome could avoid a trial without catheter for some men. Intravesical prostatic protrusion and not prostate volume has been shown to predict trial without catheter outcome in an Asian cohort. We investigated the relationship between the outcome of trial without catheter and prostate volume and intravesical prostatic protrusion in white men given alpha-blockers before a trial without catheter.
Consecutive men 50 years old or older presenting with acute urinary retention were prospectively recruited based on strict selection criteria. At presentation factors thought to precipitate acute urinary retention were treated, alpha-blocker therapy started and the patient brought back for a trial without catheter after 2 weeks. Prostate volume and intravesical prostatic protrusion were measured by standard transrectal ultrasonography.
Of 121 men presenting with acute urinary retention 57 fulfilled the study selection criteria. Mean (+/- SD) age, prostate volume and intravesical prostatic protrusion of recruited men were 70 +/- 9.2 years, 69.7 +/- 36.3 ml and 12.8 +/- 10.1 mm, respectively. A total of 25 men (43.9%) had a successful trial without catheter. Mean intravesical prostatic protrusion was significantly smaller in those who had a successful trial without catheter (7.2 vs 16.5 mm, 95% CI 4.5-14, p <0.001). With intravesical prostatic protrusion correlating well with prostate volume (r = 0.588), mean prostate volume was also smaller in men with a successful trial without catheter, albeit with a smaller effect size. Men with an intravesical prostatic protrusion of 10 mm or less, compared to those with a larger intravesical prostatic protrusion, were 6 times more likely to have a successful trial without catheter.
In this cohort presenting with acute urinary retention related to benign prostatic hyperplasia and receiving alpha-blockers before a trial without catheter, intravesical prostatic protrusion appears to strongly predict the outcome of a trial without catheter. A trial without catheter is more likely to fail in patients with intravesical prostatic protrusion larger than 10 mm.
在患有急性尿潴留的男性中，短期使用α受体阻滞剂后不插导尿管进行试验，成功率高达50%。更好地预测结果的能力可以避免一些男性进行不插导尿管的试验。在一个亚洲队列中，已证明膀胱内前列腺突出而非前列腺体积可预测不插导尿管试验的结果。我们研究了在不插导尿管试验前接受α受体阻滞剂治疗的白人男性中，不插导尿管试验结果与前列腺体积和膀胱内前列腺突出之间的关系。
根据严格的入选标准，前瞻性招募年龄在50岁及以上、患有急性尿潴留的连续男性患者。就诊时，对认为会引发急性尿潴留的因素进行治疗，开始α受体阻滞剂治疗，并在2周后让患者回来进行不插导尿管的试验。通过标准经直肠超声测量前列腺体积和膀胱内前列腺突出情况。
在121名患有急性尿潴留的男性中，57名符合研究入选标准。入选男性的平均（±标准差）年龄、前列腺体积和膀胱内前列腺突出分别为70±9.2岁、69.7±36.3毫升和12.8±10.1毫米。共有25名男性（43.9%）不插导尿管试验成功。不插导尿管试验成功的患者，其平均膀胱内前列腺突出明显较小（7.2对16.5毫米，95%可信区间4.5 - 14，p<0.001）。由于膀胱内前列腺突出与前列腺体积相关性良好（r = 0.588），不插导尿管试验成功的男性平均前列腺体积也较小，尽管效应大小较小。膀胱内前列腺突出10毫米或更小的男性与膀胱内前列腺突出较大的男性相比，不插导尿管试验成功的可能性高6倍。
在这个因良性前列腺增生而患有急性尿潴留且在不插导尿管试验前接受α受体阻滞剂治疗的队列中，膀胱内前列腺突出似乎强烈预测不插导尿管试验的结果。膀胱内前列腺突出大于10毫米的患者，不插导尿管试验更有可能失败。
