Does acute urinary retention respond to alpha-blockers alone?

Studies show that men who undergo prostatectomy after acute urinary retention (AUR) are at increased risk of intraoperative complications, transfusions, postoperative complications and hospital death. Urethral catheterisation for AUR has also been shown to result in bacterial colonization at a rate of 4% per day. Consequently, it is preferable that patients undergo a trial without catheter (TWOC) after an episode of AUR to potentially avoid surgery altogether, or to avoid having a urinary catheter in situ even if they do come to prostatectomy. A number of small studies indicate that alpha(1) blockers may improve the success rate of a TWOC. A placebo-controlled TWOC study of alfuzosin in 81 patients with AUR shows that a successful TWOC was achieved in 55% of alfuzosin-treated patients compared with 29% in the placebo group (p = 0.03). Long-term follow-up suggest that 32% (11/34; 22 treated with alfuzosin and 12 with placebo) of the patients had a further episode of AUR at a mean of 4.1 months following their first episode. This shows that there is a window of opportunity for surgical intervention prior to the occurrence of a second episode of AUR. Patients who had a subsequent episode of AUR or who needed surgery were found to have a higher post-void residual (PVR) urine following their successful TWOC, and thus may be identified as candidates for close follow-up and early intervention. As alfuzosin has been shown to reduce PVR, this factor may help prevent recurrent retention following TWOC.