Prediction of Failure of TWOC in Pts with Acute Retention of Urine due to BPH
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.
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 Î±-Blockers
were the recommended Treatment. There were many studies indicating the duration
for catheter drainage prior to Removal after initiation of Î±-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 Î±-Blocker.
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).
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 â‰¥20), pain during a
DRE, high urine volume after catheterization (V â‰¥950 mL), and high blood urea
(urea â‰¥4.55 mmol/L ie, 12.54mg/dL). Age and prostate size under ultrasound did
not show any association with the TWOC results.
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
With warm regards,