Hypothesis / aims of study
ICS defines Chronic Urinary Retention (CUR) as non-painful bladder, where there is a chronic high Post-Void Residual (PVR). There are no strict criteria for high PVR. Although some investigators consider >300-400 mls as a high residual, the definition of high PVR is subjective. Moreover, there is a lack of clear guidelines on the management of CUR resulting in an inconsistency in the approach towards offering bladder outflow surgery to these patients. It is postulated that high residual volumes with weak detrusor function result in poor surgical outcomes. Pre-operative utilisation of urodynamic studies (UDS) is also variable among clinicians ranging from strict adherence to complete omission. The aim of this retrospective electronic patient record (EPR) based study was to evaluate a correlation between high post-void bladder residuals and successful voiding after Transurethral resection of prostate (TURP) in patients with chronic urinary retention (CUR).
Study design, materials and methods
A database of all patients having undergone TURP in our hospital between March 2012 and December 2018 was obtained from the histopathology department. Their EPRs were studied to identify patients with CUR defined as any combination of enlarged non-painful bladder along with large residual volume on initial catheterisation, impaired renal function and upper tract dilatation on radiological imaging. Data on basic demographics, relevant comorbidities, residual volumes, pre-operative UDS and surgical outcomes were extracted. A successful outcome was defined as complete freedom from catheter. Based on this defintion, the dataset was divided into two groups - ‘success’ and ‘failure’. Statistical analysis was carried out using SPSS software to obtain the results.
Interpretation of results
Our results indicate that age has a bearing on predicting outcomes of TURP for CUR, whilst post-void residual volumes and comorbidities do not have any such correlation. One of the reasons for initial failure of outflow surgery could be incomplete relief of obstruction. Routine use of pre-operative Urodynamics could have resulted in avoidance of TURP. Among those who did not have pre-operative UDS only one-third of patients had a successful outcome.