Delayed vs 24h TWOC in patients with BPH and first episode of acute retention

Report By: Aleksandr Valkov - SpR
Search checked by Aleksandr Valkov - SpR
Institution: Hope Hospital
Date Submitted: 21st April 2002
Last Modified: 5th March 2010
Status: Blue (submitted but not checked)

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

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

Search Outcome

678 papers found with 1 cochrane systematic review

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Griffiths R, Fernandez R 18 April 2007 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

Comment(s)

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.

Clinical 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) Copyright © 2009 The Cochrane Collaboration. Published by JohnWiley & Sons, Ltd. 9-11, 66-79