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Yang, Ji, Song, Kim, and Moon: Factors Causing Acute Urinary Retention after Transurethral Resection of the Prostate in Patients with Benign Prostate Hyperplasia
Original Article

Korean J Androl 2011;29(2):168-173.

Published online: 22 August 2011

DOI: https://doi.org/10.5534/kja.2011.29.2.168

Factors Causing Acute Urinary Retention after Transurethral Resection of the Prostate in Patients with Benign Prostate Hyperplasia

So Jun Yang, Yoon Seob Ji, Phil Hyun Song, Hyun Tae Kim, Ki Hak Moon

Department of Urology, Yeungnam University College of Medicine, Deagu, Korea

Received 2 June 20114 August 2011       Accepted 8 August 2011

Copyright © 2011 Journal of the Korean Society for Male Gynecology

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.

Keywords: Transurethral resection of prostate, Urinary retention, Benign prostatic hyperplasia

REFERENCES

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Fig. 1.
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).
kja-29-168f1.tif
Fig. 2.
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).
kja-29-168f2.tif
Table 1.
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.

Table 2.
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.

Table 3.
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.

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