A prospective randomized trial comparing transurethral prostatic resection and clean intermittent self‐catheterization in men with chronic urinary retention

• Published in: BJU international 2005-07, Vol.96 (1), p.93-97
• Main Authors: Ghalayini, Ibrahim Fathi, Al‐Ghazo, Mohammed A., Pickard, Robert S.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Algorithms; Biological and medical sciences; Chronic Disease; Humans; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Prospective Studies; prostate; prostatic hyperplasia; Prostatic Hyperplasia - complications; Prostatic Hyperplasia - physiopathology; Prostatic Hyperplasia - surgery; Transurethral Resection of Prostate; Urinary Catheterization - methods; urinary retention; Urinary Retention - etiology; Urinary Retention - physiopathology; Urinary Retention - therapy; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; Urodynamics
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1111/j.1464-410X.2005.05574.x

OBJECTIVE To determine whether a preliminary period of clean intermittent self‐catheterization (CISC) before transurethral resection of the prostate (TURP) improves bladder contractility and surgical outcome in men with chronic urinary retention (CUR), and whether pressure‐flow studies (PFS) before TURP predict the outcome. PATIENTS AND METHODS The study was a two‐centre, pragmatic and randomized trial. Included were 41 men scheduled for TURP with lower urinary tract symptoms (LUTS), an International Prostate Symptom Score (IPSS) of > 7, benign prostatic enlargement and a persistent postvoid residual urine volume (PVR) of > 300 mL. They had conventional PFS using unphysiological filling. The patients then gave consent and were randomized into two treatment groups; the first had TURP after stabilizing renal function by indwelling catheterization if indicated, and the second was taught CISC. Men in both groups were reviewed at 3 and 6 months after surgery or the start of CISC, by the IPSS, urine culture and assay of plasma creatinine, and upper tract imaging and repeat PFS at 6 months. The primary outcome variables were IPSS, maximum urinary flow rate, voiding and end‐filling pressures, and mean PVR; secondary variables included treatment failure, complications and other urodynamic measures. RESULTS Of the 41 patients, 17 (mean age 67 years, range 52–84) were randomized to immediate TURP and 24 (mean age 69 years, range 55–85) to CISC. There was a significant improvement in IPSS and quality of life at 6 months in both groups (P