Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA.
Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA.
Urology. 2022 Oct;168:169-174. doi: 10.1016/j.urology.2022.05.035. Epub 2022 Jun 10.
To determine the predictive value of voiding efficiency on acute urinary retention after discharge from BPH surgery.
We performed a prospective observational cohort study of three surgeons' practices from 2019 to present. All men included underwent trial of void on post-operative day one after transurethral resection of prostate or Holmium enucleation of prostate . Active filling void trials were performed on all patients and voiding efficiency (percent of bladder volume emptied) was calculated. Multivariable logistic regression was performed to determine predictors of developing acute urinary retention.
During the study period, 188 men met inclusion criteria. 110 (59%) men underwent Holmium enucleation of prostate , and 78 (41%) underwent transurethral resection of prostate. The median age of our cohort was 70 (IQR 65-75). The median prostate size was 100g (IQR 61-138g). Nineteen patients (10%) returned after discharge with acute urinary retention requiring catheterization. On post-operative day one, the median voiding efficiency was 75% (IQR 55%-94%). On multivariable analysis, patients with a voiding efficiency less than 50% were 3.8 times more likely (95% confidence interval 1.1-12.8) to develop subsequent retention compared to a voiding efficiency of greater than 75%. Increasing pre-operative prostate size was associated with lower risk of urinary retention after discharge (aOR 0.8, 95%CI 0.6-0.9).
Voiding efficiency after an active void trial helps stratify risk of urinary retention in patients undergoing benign prostate surgery. High-risk patients include those with voiding efficiencies less than 50% and smaller pre-operative prostate sizes (<80g).
确定排尿效率对良性前列腺手术后出院后急性尿潴留的预测价值。
我们对 2019 年至今三位外科医生的实践进行了前瞻性观察队列研究。所有纳入的男性患者均在经尿道前列腺切除术或钬激光前列腺剜除术后第 1 天进行自主排尿试验。对所有患者进行主动充盈排尿试验，并计算排尿效率（排空膀胱体积的百分比）。采用多变量逻辑回归确定发生急性尿潴留的预测因素。
在研究期间，188 名男性符合纳入标准。110 名（59%）男性接受了钬激光前列腺剜除术，78 名（41%）接受了经尿道前列腺切除术。我们队列的中位年龄为 70 岁（IQR 65-75）。前列腺中位大小为 100g（IQR 61-138g）。19 名患者（10%）出院后因急性尿潴留需要导尿而返回。术后第 1 天，中位排尿效率为 75%（IQR 55%-94%）。多变量分析显示，排尿效率小于 50%的患者发生后续潴留的可能性是排尿效率大于 75%的患者的 3.8 倍（95%置信区间 1.1-12.8）。术前前列腺体积增大与出院后尿潴留风险降低相关（aOR 0.8，95%CI 0.6-0.9）。
自主排尿试验后的排尿效率有助于分层良性前列腺手术患者尿潴留的风险。高危患者包括排尿效率小于 50%和术前前列腺体积较小（<80g）的患者。
