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

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.