THE MANAGEMENT OF MEN WITH ACUTE URINARY RETENTION

Objectives To determine the outcome of men with acute urinary retentio n undergoing prostatectomy and to assess whether discharge with a cath eter before subsequent planned re-admission for prostatectomy had an a dverse effect on outcome. Patients and methods A prospective cohort st udy was conducted of all men undergoing prostatectomy in five health c are regions over a 6-month period in 56 hospitals where prostatectomie s were performed under the care of 103 surgeons. The study included 39 66 men undergoing prostatectomy. of whom 1242 presented with acute uri nary retention; the complication rates and symptomatic outcome were as sessed. Results Compared with those who underwent elective prostatecto my for symptoms alone, men presenting with acute retention had an exce ss risk of death at 30 days (relative risk [RR], 26.6, 35% confidence interval [CI], 3.5-204.5) and at 90 days after operation (RR 4.4, 95% CI 2.5-7.6), and an increased risk of perioperative complications. Alt hough men with retention were older, had larger glands and had more co morbidity, these factors did not totally explain the excess risk. The final symptomatic outcome of men with acute retention was no different from that of men presenting for elective treatment. Men with retentio n who were managed by initial catheterization, sent home and subsequen tly re-admitted for planned operation had similar pretreatment charact eristics, post-operative complications and outcomes to those who were kept in hospital throughout, although the men kept in hospital had a t otal increased length of stay. Conclusions Men with acute retention ha ve a high risk of developing complications after undergoing prostatect omy. We were unable to confirm that a shortterm period of catheter dra inage at home before re-admission for planned surgery carried increase d risks of peri-operative complications.