
Venugopal P
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24 Nov 2024 01:27:43 PMPrediction of Failure of TWOC in Pts with Acute Retention of Urine due to BPH
Dear All,
We have
observed even in the past where patients with Acute Retention of Urine due to
BPH commence passing Urine adequately on Catheter removal on many occasions.
During those years, we had only two options for patients with BPH. Either
subject them to Surgery or wait full watching. Patients with Retention of Urine
were offered surgical treatment as a routine. But some patients who refused
surgery, catheter was removed and some passed urine adequately.
Since the
advent of Medical therapies for BPH, Initially Medical treatments were not
advised for patients with retention of urine. But this scenario changed gradually
with many patients subjected to TWOC on commencement of Medical treatments and α-Blockers
were the recommended Treatment. There were many studies indicating the duration
for catheter drainage prior to Removal after initiation of α-Blockers. Many studies
indicated that longer the catheter stay, higher the chances of development of
UTI. The general consensus now appear to be 3 days of catheter drainage after
the commencement of α-Blocker.
Not all
patients on TWOC succeed. There are many views expressed on prediction of
failure to TWOC. Notably among them are the views Expressed by Bhomi and
Bhattachan (2011), Fitzpatrick et al
(2012) and Manjunath and Hofer (2018).
I am
providing an article by Dinh Thi Phuong Hoai, Le Dinh Khanh* et al (2021) wherein they have come out with
some newer facts apart from those mentioned the previous workers mentioned. The
proposed predictive factors of TWOC failure in this study were severe urinary
tract symptoms (IPSS ≥20), pain during a
DRE, high urine volume after catheterization (V ≥950 mL), and high blood urea
(urea ≥4.55 mmol/L ie, 12.54mg/dL). Age and prostate size under ultrasound did
not show any association with the TWOC results.
https://www.e-urol-sci.com/article.asp?issn=1879-5226;year=2021;volume=32;issue=2;spage=71;epage=76;aulast=Phuong
(PDF available)
https://www.e-urol-sci.com/temp/UrolSci32271-1493326_040853.pdf
I have found that failure to TWOC is often associated with
duration of symptoms prior to the patient developing Retention of Urine. Longer
the Duration of symptoms higher the TWOC failure.
With many of us now practicing TWOC and if successful, the
patients are treated on continued Medication. Even if the patient develops re
Retention, many are suggesting Re TWOC as an option.
This is a subject where Urologists have different views and
expressing divergent views, if any, would help us to understand the usefulness of
TWOC.
With warm regards,
Venu
Comments(2)
-
Ravindra Sabnis
09 Aug 2021 04:00:19 PMI agree, in past, acute retention was definative indication of surgery, when alpha blocker did not exist.
With advent of alpha blockers, whole scenario has changed. Now TOWC is standard of care. However as rightly mentioned in article, if some factors are present he should be told to get elective surgery done - if he is already taking medication for long time.Re acute retention I would consider as certain indication for surgery unless there is clear precipitating cause for retention - like abscess, common cold medicines, piles or pose anal surgery...etc
Venugopal P
07 Aug 2021 10:03:26 AMDear All,
Some of you may be finding difficulty in opening the article from the link. Hence I am sending the PDF of the article mentioned in the Post above.
Venu
View Document