Emberton Mark, Fitzpatrick John M
University College London, London, UK.
BJU Int. 2008 Mar;101 Suppl 3:27-32. doi: 10.1111/j.1464-410X.2008.07491.x.
Acute urinary retention (AUR) is a urological emergency characterized by a sudden and painful inability to pass urine. It represents a significant worldwide public health issue, as mortality within the year following an AUR episode appears much higher than in the general population, especially in younger patients. Management of AUR involves immediate bladder catheterization usually followed, until recently, by prostatic surgery. The greater morbidity and mortality associated with emergency surgery (within a few days after AUR), and the potential morbidity associated with prolonged catheterization (bacteriuria, fever, urosepsis) has led to an increasing use of a trial without catheter (TWOC). TWOC involves catheter removal after 1-3 days, allowing 23-40% of patients to void successfully, so that surgery can be performed at a later stage, if needed. Use of an alpha(1)-blocker before a TWOC may also be of help, as it has been demonstrated that it increases the chances of successful voiding after catheter removal. In the UK, this TWOC policy has resulted in a progressive decrease in the number of surgical procedures following a first episode of AUR, with the detriment of a slight increase in the AUR recurrence rate. Currently, there is no consensus on the optimal management of AUR in terms of type of catheterization, duration of catheterization and management following catheterization. The Reten-World survey is aimed at assessing current practice in the management of AUR in France, Asia, Latin America, North Africa and the Middle East. Interim results based on 3785 men with AUR associated with benign prostatic hyperplasia show that a urethral catheter is inserted in most cases (87%). Following this initial step, a TWOC after a median of 3 days' catheterization has become standard practice worldwide, with only a minority of men (6%) undergoing immediate surgery. Treatment with an alpha(1)-blocker before a TWOC improves the chances of success, regardless of the duration of catheterization. There is also evidence that prolonged catheterization (>3 days) is associated with a significantly higher rate of comorbidity and prolonged hospitalization due to adverse events. Every effort should thus be made to reduce the comorbidity and mortality associated with AUR.
急性尿潴留（AUR）是一种泌尿外科急症，其特征为突然且伴有疼痛的排尿困难。它是一个重大的全球公共卫生问题，因为AUR发作后一年内的死亡率似乎远高于普通人群，尤其是年轻患者。AUR的治疗通常包括立即进行膀胱插管，直到最近，后续还会进行前列腺手术。与急诊手术（AUR后数天内）相关的更高发病率和死亡率，以及与长期插管相关的潜在发病率（菌尿、发热、尿脓毒症），导致无导尿管试验（TWOC）的使用越来越多。TWOC包括在1 - 3天后拔除导尿管，使23% - 40%的患者能够成功排尿，以便在需要时可在后期进行手术。在TWOC前使用α1受体阻滞剂可能也有帮助，因为已证明它可增加拔除导尿管后成功排尿的几率。在英国，这种TWOC策略导致首次AUR发作后手术程序数量逐渐减少，但AUR复发率略有上升。目前，在导尿类型、导尿持续时间及导尿后管理方面，对于AUR的最佳治疗尚无共识。Reten - World调查旨在评估法国、亚洲、拉丁美洲、北非和中东地区AUR管理的当前实践。基于3785例与良性前列腺增生相关的AUR男性患者的中期结果显示，大多数情况下（87%）会插入尿道导尿管。在这一初始步骤之后，导尿中位数为3天后进行TWOC已成为全球标准做法，只有少数男性（6%）接受立即手术。无论导尿持续时间如何，在TWOC前使用α1受体阻滞剂可提高成功几率。也有证据表明，长期导尿（>3天）与因不良事件导致的更高合并症发生率和更长住院时间相关。因此，应尽一切努力降低与AUR相关的合并症和死亡率。
