kja Korean Journal of Andrology Korean J Androl 1229-1692 Journal of the Korean Society for Male Gynecology 10.5534/kja.2011.29.2.168 kja-29-168 Original Article Factors Causing Acute Urinary Retention after Transurethral Resection of the Prostate in Patients with Benign Prostate Hyperplasia Yang So Jun Ji Yoon Seob Song Phil Hyun Kim Hyun Tae Moon Ki Hak Department of Urology, Yeungnam University College of Medicine, Deagu, Korea 82011 2282011 292 168173 02062011 04082011 08082011 Copyright © 2011 Journal of the Korean Society for Male Gynecology 2011 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Purpose

Urologists occasionally experience some cases of voiding failure after transurethral resection of prostate (TURP). Preoperative and postoperative factors attributable to acute urine retention (AUR) after catheter removal in post-TURP patients were evaluated and analyzed to determine the causative factors for AUR.

 Materials and Methods

From June 2004 to May 2008, a total of 172 patients who underwent TURP due to symptomatic benign prostatic hyperplasia (BPH) were divided into the AUR group (n=21) and the control group (n=151). The AUR group was defined as patients with voiding difficulty within 24 hours and whose residual urine volume was above 400 ml after catheter removal. The control group was defined as patients without AUR. Age, duration of symptoms, International prostate symptom score (IPSS), Quality of life score (QoL), uroflowmetry, post-void residual urine volume, preoperative serum prostate specific antigen (PSA) level, preoperative prostate volume, resected prostate volume, rate of prostate resection [resected prostate volume/preoperative prostate volume×100], operative time and duration of catheter were retrospectively analyzed to identify which of these were the factors related with AUR after catheter removal in post-TURP patients.

 Results

Preoperative prostate volume was higher (90.7±50.4 vs 64.4±32.7, p=0.002) and rate of prostate resection was lower (38.8±8.1 vs 50.5±12.4, p＜0.001) in AUR group compared to control group. And age, duration of symptoms, IPSS, QoL, uroflowmetry, post-void residual urine volume, preoperative serum PSA level, resected prostate volume, operative time and duration of catheter were not statistically significant in both groups. The multivariate analysis subsequently showed that preoperative prostate volume (p=0.010, OR=1.040) and rate of prostate resection (p=0.001, OR=0.901) were independent factors related with AUR after catheter removal in post-TURP patients.

 Conclusions

The incidence of AUR after catheter removal was higher in post-TURP patients with high preoperative prostate volume and low rate of prostate resection. Therefore the surgeon's effort to increase the rate of prostate resection, especially in patients with large prostate volume, may lower the incidence of postoperative AUR.

 Transurethral resection of prostate Urinary retention Benign prostatic hyperplasia REFERENCES Han KS Hong SJ Chung BH Changing trends in the management of benign prostatic hyperplasia during recent 5 years Korean J Urol 200546 45862 Kwak DY Chang HS Park CH Kim CI Longterm results of transurethral resection of the prostate for large benign prostatic hyperplasia: a comparative study with open prostatectomy Korean J Urol 200849 316 Baek M Paick SH Lee BK Kang MB Lho YS Jung SI The efficacy of bipolar transurethral resection of the prostate in patients with large prostates(＞80 g) and analysis of the postoperative results based on the resection ratio Korean J Urol 200849 108793 Kim HG Lee BK Paick SH Lho YS Efficacy of bipolar transurethral resection of the prostate: comparison with standard monopolar transurethral resection of the prostate Korean J Urol 200647 37780 Hakenberg OW Helke C Manseck A Wirth MP Is there a relationship between the amount of tissue removed at transurethral resection of the prostate and clinical improvement in benign prostatic hyperplasia Eur Urol 200139 4127 Rassweiler J Teber D Kuntz R Hofmann R Complications of transurethral resection of the prostate (TURP)–incidence, management, and prevention Eur Urol 200650 96979 Bishop P Bipolar transurethral resection of the prostate–a new approach AORN J 200377 97983 Reich O Gratzke C Bachmann A Seitz M Schlenker B Hermanek P Urology Section of the Bavarian Working Group for Quality Assurance Morbidity, mortality and early outcome of transurethral resection of the prostate: a prospective multicenter evaluation of 10,654 patients J Urol 2008180 2469 Lim KB Wong MY Foo KT Transurethral resection of prostate (TURP) through the decades–a comparison of results over the last thirty years in a single institution in Asia Ann Acad Med Singapore 200433 7759 Starkman JS Santucci RA Comparison of bipolar transurethral resection of the prostate with standard transurethral prostatectomy: shorter stay, earlier catheter removal and fewer complications BJU Int 200595 6971 Oh CS Choi KY Park RJ Relationship between the amount of tissue removed at transurethral resection of the prostate and clinical improvement in benign prostate hyperplasia Korean J Urol 200344 86670 Aagaard J Jonler M Fuglsig S Christensen LL Jorgensen HS Norgaard JP Total transurethral resection versus minimal transurethral resection of the prostate–a 10-year follow-up study of urinary symptoms, uroflowmetry and residual volume Br J Urol 199474 3336 Chen SS Hong JG Hsiao YJ Chang LS The correlation between clinical outcome and residual prostatic weight ratio after transurethral resection of the prostate for benign prostatic hyperplasia BJU Int 200085 7982 Chang HS Park CH Kim CI Transitional zone volume: a predictor of acute urinary retention in patients with benign prostatic hyperplasia Korean J Urol 200546 25963 Jacobsen SJ Jacobson DJ Girman CJ Roberts RO Rhodes T Guess HA Natural history of prostatism: risk factors for acute urinary retention J Urol 1997158 4817 Wein AJ Lower urinary tract dysfunction in neurologic injury and disease Wein AJ Kavoussi LR Novick AC Partin AW Peters CA Campbell's urology. 9th ed. Philadelphia Saunders 200720401 Figures and Tables

Comparison of preoperative prostate volume between acute urine retention (AUR) and control group. Bars are mean±standard error of mean (∗Statistical significance was evaluated by Multiple logistic regression analysis, p＜0.05).

Comparison of rate of resected volume to prostatic volume between acute urine retention (AUR) and control group. Bars are mean±standard error of mean (∗Statistical significance was evaluated by Multiple logistic regression analysis, p＜0.05).

Comparison of preoperative characteristics between AUR and control group

Variables AUR group (n=21) Mean±S.D. Control group (n=151) Mean±S.D. p-value
Age (years) 70.5±7.2 69.1±7.7 0.439
BMI (kg/m2) 23.3±3.1 25.1±3.5 0.427
Duration of BPH (months) 47.6±35.6 54.6±60.9 0.606
Pre-medication No. of patients (%) (α-blocker±5 ARI) 15 (71.4) 121 (80.1) 0.419
IPSS
 Total (score) 23.5±4.7 23.0±5.8 0.708
 Voiding symptom (score) 15.15±2.4 14.03±3.2 0.712
 Storage symptom (score) 8.35±1.9 8.97±2.8 0.546
QOL (score) 5.0±0.8 4.7±0.9 0.275
MFR (ml/sec) 9.2±3.1 10.0±5.5 0.515
Voided volume (ml) 163.6±58.0 165.0±96.2 0.946
PVR (ml) 121.5±97.8 107.8±90.8 0.523
Serum PSA level (ng/ml) 3.0±1.9 2.3±1.7 0.078
Preoperative prostate volume (cc) 90.7±50.4 64.4±32.7 0.002

AUR: acute urinary retention, BMI: body mass index, BPH: benign prostate hyperplasia, 5ARI: 5 alpha reductase inhibitor, IPSS: international prostate symptom score, QOL: quality of life, MFR: maximumflow rate, PVR: post-void residual urine volume, PSA: prostate specific antigen.

Statistical significance was evaluated by Student's t-test, p＜0.05.

Comparison of intraoperative and postoperative characteristics between AUR and control group

Variables AUR group (n=21) Control group (n=151) p-value
Mean±S.D. Mean±S.D.
Resected volume (cc) 35.3±18.7 32.1±17.2 0.421
Rate of resected volume to preoperative prostate volume (%) 38.8±8.1 50.5±12.4 ＜0.001
Operative time (min) 93.1±49.0 86.4±39.4 0.481
Duration of postoperative catheterization 3.2±1.0 3.4±1.3 0.701

AUR: acute urine retention, BPH: benign prostate hyperplasia, Rate of resected volume to preoperative prostate volume: Resection volume/Prostate volume ×100.

Statistical significance was evaluated by Student's t-test, p＜0.05.

Multiple logistic regression analysis for independent variables for acute urinary retention after transurethral resection of prostate

Odds ratio 95% confidence interval p-value
Lower Upper
QOL 1.293 0.744 2.249 0.362
Serum PSA level 0.560 0.295 1.061 0.076
Preoperative prostate volume 1.040 1.009 1.071 0.010
Rate of resected volume to preoperative prostate volume 0.901 0.849 0.956 0.001

QOL: quality of life, PSA: prostate specific antigen, Rate of resected volume to preoperative prostate volume: Resection volume/Prostate volume ×100.