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.