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Early vs Delayed Transurethral Surgery in Acute Urinary Retention: Does Timing Make a Difference?

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Early transurethral surgery for benign prostatic hyperplasia (BPH) is linked to better outcomes. Delaying surgery after acute urinary retention increases the risk of treatment failure and reoperation.

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Area of Science:

  • Urology
  • Surgical Outcomes
  • Health Services Research

Background:

  • Benign prostatic hyperplasia (BPH) is a common condition in aging men.
  • Acute urinary retention (AUR) is a common complication of BPH, often requiring catheterization.
  • The optimal timing for surgical intervention after AUR remains debated.

Purpose of the Study:

  • To compare long-term surgical outcomes in men undergoing transurethral surgery for BPH.
  • To evaluate the impact of preoperative acute urinary retention (AUR) and delayed surgery on treatment failure.
  • To assess if the number of AUR episodes influences postoperative outcomes.

Main Methods:

  • Retrospective cohort analysis of 17,474 men undergoing transurethral surgery for BPH (2002-2016).
  • Patients categorized by absence or presence (1 or ≥2 episodes) of preoperative AUR and time to surgery (0-6 months or >6 months).
  • Fine-Gray competing-risk models used to predict 10-year surgical failure (reoperation or recatheterization), with death as a competing risk.

Main Results:

  • 10% of patients experienced preoperative AUR, with 37% facing delays of ≥6 months to surgery.
  • 10-year treatment failure rates were 17.2% (no AUR), 34.0% (≥2 AUR episodes), and 32.9% (≥6 months delay).
  • Delays in surgery post-catheterization significantly increased treatment failure risk (SHR 1.49 for <6 months, SHR 2.11 for ≥6 months).

Conclusions:

  • Preoperative acute urinary retention is associated with significantly poorer long-term outcomes after BPH surgery.
  • Delayed surgical intervention following catheterization for AUR leads to higher rates of treatment failure.
  • Timely surgical management is crucial for optimizing long-term results in men with BPH and AUR.