JU INSIGHT Early vs Delayed Transurethral Surgery in Acute Urinary Retention: Does Timing Make a Difference?
By: Daniel M. Frendl, MD, PhD*, Massachusetts General Hospital, Harvard Medical School, Boston, Mayo Clinic, Phoenix, Arizona; Wesley H. Chou, MD*, Massachusetts General Hospital, Harvard Medical School, Boston; Ya-Wen Chen, MD, MPH, Codman Center, Massachusetts General Hospital, Harvard Medical School, Boston; David C. Chang, PhD, Codman Center, Massachusetts General Hospital, Harvard Medical School, Boston; Michelle M. Kim, MD, PhD, Massachusetts General Hospital, Harvard Medical School, Boston *Co-first authors | Posted on: 19 Sep 2023
Frendl DM, Chou WH, Chen YW, Chang DC, Kim MM. Early vs delayed transurethral surgery in acute urinary retention: does timing make a difference?. J Urol. 2023;210(3):492-499.
Study Need and Importance
Acute urinary retention is one of the most common diseases among older men. Management ranges from pharmacological treatment to prostate debulking surgery. We were interested in whether long-term outcomes differed among men who underwent early prostate debulking surgery after an event of urinary retention compared to men who had a delayed surgical intervention.
What We Found
We examined 17,474 men who underwent prostate debulking surgery and found that men who had surgery more than 6 months after their initial urinary retention episode had a higher risk of subsequent reoperation and recatheterization at 10 years compared to men who had not been catheterized. Those who had a higher number of preoperative catheterizations had higher rates of failure.
Our study was conducted using claims data, which may not capture important clinical factors such as preoperative prostate size, duration of catheterization, pharmacological utilization, and clinical assessments of bladder function that affect surgical decision-making. Additionally, we did not have ambulatory claims, which may miss outpatient catheterization episodes. There is also a potential for misclassification of catheterization events in terms of the indication for acute retention vs other causes, although we only considered catheterization events associated with a benign prostatic hyperplasia (BPH) diagnosis. Furthermore, although we attempted to exclude any patients with underlying neurological conditions contributing to bladder dysfunction, without robust clinical data we cannot be certain that patients’ retention episodes could entirely be attributed to progressive bladder outlet obstruction from BPH.
Interpretation for Patient Care
Our work suggests that prompt referral to urology should be considered for patients with acute retention to more closely evaluate for bladder outlet obstruction and evaluate whether they may be candidates for surgery. Additionally, it may be beneficial for men with lower urinary tract symptoms to consider BPH surgery before progressing to retention, thereby avoiding the progression to acute urinary retention and prolonged catheterization.