Intravesical prostatic protrusion is better than prostate volume in predicting the outcome of trial without catheter in white men presenting with acute urinary retention: A prospective clinical study
Intravesical prostatic protrusion is better than prostate volume in predicting the outcome of trial without catheter in white men presenting with acute urinary retention: A prospective clinical study
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DOI：
10.1016/j.juro.2007.03.116
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发表时间：
2007-08-01
影响因子：
6.6
通讯作者：
McNeill, Alan S.
中科院分区：
文献类型：
--
作者：
Mariappan, Paramananthan;Brown, David J. G.;McNeill, Alan S.
目的：在男性急性尿潴留患者中，短期服用a受体阻滞剂后不使用导管的试验成功率高达50%。对一些男性来说，更好地预测结果的能力可以避免没有导管的试验。在一项亚洲队列研究中，膀胱内前列腺突出而非前列腺体积可预测无导管试验的结果。我们研究了无导管试验结果与前列腺体积和膀胱内容积的关系。在没有导管的情况下试用a受体阻滞剂的白人男性前列腺突出。材料和方法：根据严格的选择标准前瞻性地招募50岁及以上出现急性尿潴留的连续男性。在被认为引起急性尿潴留的表现因素得到治疗后，开始a受体阻滞剂治疗，患者在2周后再次接受无导尿管试验。采用标准经直肠超声检查前列腺体积和膀胱内前列腺突出。结果：121名出现急性尿潴留的男性中，57人符合研究选择标准。平均（SD）年龄、前列腺体积和膀胱内前列腺突出分别为70 +/- 9.2岁、69.7 +/- 36.3 ml和12.8 +/- 10.1 mm。共有25名男性（43.9%）在没有导管的情况下试验成功。在没有导管的情况下试验成功的患者中，平均膀胱内前列腺突出明显更小（7.2 vs 16.5 mm, 95% CI 4.5-14, p < 0.001）。膀胱内前列腺突出与前列腺体积相关良好（r = 0.588），无导管试验成功的男性平均前列腺体积也较小，尽管效果较小。膀胱内前列腺突出小于等于10mm的男性，与膀胱内前列腺突出较大的男性相比，无导管试验成功的可能性高6倍。结论：在这个队列中，出现与良性前列腺增生相关的急性尿潴留，并在无导管试验前接受a受体阻滞剂治疗，膀胱内前列腺突出似乎强烈地预测了无导管试验的结果。在膀胱内前列腺突出大于10mm的患者中，没有导管的试验更容易失败。
Purpose: Trial without catheter after a short course of an a-blocker in men presenting with acute urinary retention is successful in up to 50% of cases. The ability to better predict outcome could avoid a trial without catheter for some men. Intravesical prostatic protrusion and not prostate volume has been shown to predict trial without catheter outcome in an Asian cohort. We investigated the relationship between the outcome of trial without catheter and prostate volume and intravesical. prostatic protrusion in white men given a-blockers before a trial without catheter.Materials and Methods: Consecutive men 50 years old or older presenting with acute urinary retention were prospectively recruited based on strict selection criteria. At presentation factors thought to precipitate acute urinary retention were treated, a-blocker therapy started and the patient brought back for a trial without catheter after 2 weeks. Prostate volume and intravesical prostatic protrusion were measured by standard transrectal ultrasonography.Results: Of 121 men presenting with acute urinary retention 57 fulfilled the study selection criteria. Mean ( SD) age, prostate volume and intravesical prostatic protrusion of recruited men were 70 +/- 9.2 years, 69.7 +/- 36.3 ml and 12.8 +/- 10.1 mm, respectively. A total of 25 men (43.9%) had a successful trial without catheter. Mean intravesical prostatic protrusion was significantly smaller in those who had a successful trial without catheter (7.2 vs 16.5 mm, 95% CI 4.5-14, p < 0.001). With intravesical prostatic protrusion correlating well with prostate volume (r = 0.588), mean prostate volume was also smaller in men with a successful trial without catheter, albeit with a smaller effect size. Men with an intravesical prostatic protrusion of 10 mm or less, compared to those with a larger intravesical prostatic protrusion, were 6 times more likely to have a successful trial without catheter.Conclusions: In this cohort presenting with acute urinary retention related to benign prostatic hyperplasia and receiving a-blockers before a trial without catheter, intravesical prostatic protrusion appears to strongly predict the outcome of a trial without catheter. A trial without catheter is more likely to fail in patients with intravesical prostatic protrusion larger than 10 mm.