Delayed vs 24h TWOC in patients with BPH and first episode of acute retention
Date First Published:
April 21, 2002
Last Updated:
March 5, 2010
Report by:
Aleksandr Valkov, SpR (Hope Hospital)
Search checked by:
Aleksandr Valkov, Hope Hospital
Three-Part Question:
in [a patient with BPH and first episode of acute retention] will [delayed removal of catheter] result in [more successful rate of Trial Without a Catheter]
Clinical Scenario:
An elderly Patient with the history of BPH presented in A/E department with acute retention. He was successfully catheterised; he has no signs of UTI or acute renal impairment. Some hospitals discharge these patients and arrange Trial without Catheter as OP. I wonder if early TWOC is more successful than delayed in this group of patients.
Search Strategy:
Cochrane Library
Medline 1960 to dec 2009
Embase 1980 to dec 2009
BNI
CINAHL 1981 to present
worldwide web via Google/ Google scholar- first 5 pages of the search
Medline 1960 to dec 2009
Embase 1980 to dec 2009
BNI
CINAHL 1981 to present
worldwide web via Google/ Google scholar- first 5 pages of the search
Search Details:
Cochrane library- [ catheter] or [ catheterisation] or [removal]
Medline [prostatic hypertrophy.af OR prostatic hyperplasia.af OR BPH.af OR ((urethral.af OR urinary.af OR ( Bladder.af AND outflow.af)) AND ( Block$.af OR obstruc$.ti,ab)] AND [( remov$.af OR twoc.af OR withdraw$.af OR (trial AND without).af) AND catheter.af] AND [[Limit to: Humans AND Male AND (Age Groups All Adult 19 plus years) AND English Language]
EMBASE- [prostatic hypertrophy.af OR prostatic hyperplasia.af OR BPH.af OR ((urethral.af OR urinary.af OR ( Bladder.af AND outflow.af)) AND ( Block$.af OR obstruc$.ti,ab)] AND [( remov$.af OR twoc.af OR withdraw$.af OR (trial AND without).af) AND catheter.af] AND [[Limit to: Humans AND Male AND (Age Groups All Adult 19 plus years) AND English Language]
BNI-[catheter .af] or[ urinary.af] AND [removal.af] or [TWOC]
CINAHL-[catheter .af] or[ urinary.af] AND [removal.af] or [TWOC]
Google/ Google scholar- acute urinary retention catheter
Medline [prostatic hypertrophy.af OR prostatic hyperplasia.af OR BPH.af OR ((urethral.af OR urinary.af OR ( Bladder.af AND outflow.af)) AND ( Block$.af OR obstruc$.ti,ab)] AND [( remov$.af OR twoc.af OR withdraw$.af OR (trial AND without).af) AND catheter.af] AND [[Limit to: Humans AND Male AND (Age Groups All Adult 19 plus years) AND English Language]
EMBASE- [prostatic hypertrophy.af OR prostatic hyperplasia.af OR BPH.af OR ((urethral.af OR urinary.af OR ( Bladder.af AND outflow.af)) AND ( Block$.af OR obstruc$.ti,ab)] AND [( remov$.af OR twoc.af OR withdraw$.af OR (trial AND without).af) AND catheter.af] AND [[Limit to: Humans AND Male AND (Age Groups All Adult 19 plus years) AND English Language]
BNI-[catheter .af] or[ urinary.af] AND [removal.af] or [TWOC]
CINAHL-[catheter .af] or[ urinary.af] AND [removal.af] or [TWOC]
Google/ Google scholar- acute urinary retention catheter
Outcome:
678 papers found with 1 cochrane systematic review
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Strategies for the removal of short-term indwelling urethral catheters in adults (Review) Griffiths R, Fernandez R 18-Apr-07 australia | People of all ages having a short-termindwelling urethral catheter, in any setting (hospital, community, nursing home)- 1-14 days |
Twenty-six trials involving a total of 2933 participants. Only one study (Taube, 89) reflected on patients in AUR, rather than postoperarive catheterisation. | delayed voiding (taude et all)immediate versus 24h TWOC | Rsk Ratio0.90 [ 0.63, 1.29 ]CI95%; p=0.59 | most of studies are based on postoperative catheterisation, rather than AUR, only one study concentrated on aUR,most of the other outcomes had to be excluded as they applied only to purely postoperative complications |
| delayed voiding (taude et all)immediate versus 48h delayed TWOC | Risk Ratio1.13 [ 0.74, 1.74 ]CI95%; p=0.56 | ||||
| delayed voiding(taude et al)1 day delayed versus 2 day delayed TWOC | Risk Ratio 1.26 [ 0.86, 1.85 ]CI95%; p=0.24 |
Author Commentary:
Though significant amount of evidence exists concerning timing of TWOC, most of it relates to variuos postoperative catheterisations. Data about AUR related TWOC is very limited. Only good quality study had limited numbers, and all TWOCs were performed under 3 days. It didn't find significant differences between groups.
Bottom Line:
There is no enough evidence to suggest that either early or delayed TWOC is more effective than another
References:
- Griffiths R, Fernandez R . Strategies for the removal of short-term indwelling urethral catheters in adults (Review)