Русский
Efficacy and safety of intermittent catheterization for acute urinary retention: a prospective comparative randomized study
DOI: https://dx.doi.org/10.18565/urology.2022.6.9-15
V.A. Malkhasyan, S.V. Kotov, I.E. Mamaev, S.V. Belomytcev, R.A. Perov, S.A. Pulbere, A.I. Volnukhin, D.U. Pushkar
1) A.I. Evdokimov Moscow State University of Medicine and Dentistry of Minzdrav of Russia, Moscow, Russia; 2) Municipal clinical hospital named after S.I. Spasokukotskiy of the Moscow Healthcare Department, Moscow, Russia; 3) Municipal clinical hospital № 1 named after N.I. Pirogov of the Moscow Healthcare Department, Moscow, Russia; 4) Municipal clinical hospital named after V.M. Buyanov of the Moscow Healthcare Department, Moscow, Russia; 5) Municipal clinical hospital named after V.V. Vinogradov of the Moscow Healthcare Department, Moscow, Russia; 6) Municipal clinical hospital named after S.S. Yudin of the Moscow Healthcare Department, Moscow, Russia
Objectives of the study: to evaluate the effectiveness and safety of intermittent catheterization in the management of acute urinary retention and to identify factors influencing the resume normal voiding and the development of adverse events.
Materials and methods. 129 patients admitted to urology department with acute urinary retention due to BPH were randomized into two groups. Group I had indwelling bladder catheterisation using Foly catheter. Group II was catheterized intermittently. Main outcome measures: Success rate, time to resume normal voiding, number of episodes of fever, pain, urgency and gross hematuria. Factors influencing the probability of AUR resolution and adverse events were also analyzed.
Results. Normal voiding was resumed in 25 (35.7%) patients in group I, and in 26 (44%) patients in group II. The probability of AUR resolution in group II was 1.5 times higher than in group I. However, this difference was not statistically significant. In group II normal voiding was restored within 1 day in 1 (3.8%) patient, in 12 (46.2%) – within 2 days, and in 13 (50%) – within 3 days. On the 7th day relapse of AUR occurred in 3 (2.3%) patients, in 2 (2,8%) patients in group I and in 1 (1.7%) patient in group II. Logistic regression analysis showed statistically significant association between the probability of developing gross hematuria and the age of the patient, as well as between possible urethrorrhagia and episodes of acute urinary retention previous to the last AUR episode. Statistically significant associations were revealed between age and the use of a-blockers at the time of the acute urinary retention episode and the probability AUR resolution. An increase in the patient’s age by 1 year was associated with decrease in the chances of voiding resumption by 1.07 times, and a-blockers therapy at the time of acute urinary retention increased these chances by 2.8 times. Urgency rate was statistically significantly higher in group I (30% vs. 3.4%), the chances of developing urgency were also 12 times higher in group I.
Conclusion. Intermittent catheterization is an effective method of AUR management. The major advantages of this method are the possibility of outpatient treatment, maximum preservation of patient’s social and sexual activity, earlier resumption of voiding and significantly less common catheter-associated lower urinary tract symptoms.
Materials and methods. 129 patients admitted to urology department with acute urinary retention due to BPH were randomized into two groups. Group I had indwelling bladder catheterisation using Foly catheter. Group II was catheterized intermittently. Main outcome measures: Success rate, time to resume normal voiding, number of episodes of fever, pain, urgency and gross hematuria. Factors influencing the probability of AUR resolution and adverse events were also analyzed.
Results. Normal voiding was resumed in 25 (35.7%) patients in group I, and in 26 (44%) patients in group II. The probability of AUR resolution in group II was 1.5 times higher than in group I. However, this difference was not statistically significant. In group II normal voiding was restored within 1 day in 1 (3.8%) patient, in 12 (46.2%) – within 2 days, and in 13 (50%) – within 3 days. On the 7th day relapse of AUR occurred in 3 (2.3%) patients, in 2 (2,8%) patients in group I and in 1 (1.7%) patient in group II. Logistic regression analysis showed statistically significant association between the probability of developing gross hematuria and the age of the patient, as well as between possible urethrorrhagia and episodes of acute urinary retention previous to the last AUR episode. Statistically significant associations were revealed between age and the use of a-blockers at the time of the acute urinary retention episode and the probability AUR resolution. An increase in the patient’s age by 1 year was associated with decrease in the chances of voiding resumption by 1.07 times, and a-blockers therapy at the time of acute urinary retention increased these chances by 2.8 times. Urgency rate was statistically significantly higher in group I (30% vs. 3.4%), the chances of developing urgency were also 12 times higher in group I.
Conclusion. Intermittent catheterization is an effective method of AUR management. The major advantages of this method are the possibility of outpatient treatment, maximum preservation of patient’s social and sexual activity, earlier resumption of voiding and significantly less common catheter-associated lower urinary tract symptoms.
Keywords: intermittent catheterization, trial without catheter, acute urinary retention, benign prostatic hyperplasia
About the Autors
Corresponding author: V.A. Malkhasyan – MD, professor at the Urological Department in A.I. Evdokimov Moscow State University of Medicine and Dentistry of Minzdrav of Russia, Moscow, Russia, Head of Urology Department in municipal clinical hospital named after S.I. Spasokukotskiy, Moscow, Russia; e-mail: vigenmalkhasyan@gmail.com
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