Prediction 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.;year=2021;volume=32;issue=2;spage=71;epage=76;aulast=Phuong (PDF available)  

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,



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  • Venugopal P
    Venugopal P
    07 Aug 2021 10:03:26 AM

    Dear 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.



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  • Ravindra Sabnis
    Ravindra Sabnis
    09 Aug 2021 04:00:19 PM

    I 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

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