Early Versus Late Catheter Removal in Patients With Acute Urinary Retention Secondary to Benign Prostatic Hyperplasia Under Tamsulosin Treatment
Phase: NA
Conditions: BPH With Urinary Obstruction
Sponsor: Salem Hassan Salem Mohamed

Al -Azhar University
Faculty Of Medicine 
Urology Department 
Early Versus late Catheter Removal in Patients with Urinary 
Retention Secondary to Benign Prostatic Hyperplasia under 
Tamsulosin Treatment 
Thesis 
Submitted for Partial Fulfillment of 
Master Degree in Urology 
 By 
Salem Hassan Salem Mohamed 
M.B.B.Ch 
Supervised By 
Prof.  Dr.Mohamed Mabrouk Badr 
Professor of Urology– Al Azhar University 
Dr. Mohamed Fathy El Saeed  El Ebiary 
Lecturer of Urology – Al Azhar University 
March 10 ,2017 

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INTRODUCTION 
Benign prostatic hyperplasia (BPH) is defined as the proliferation of prostatic stromal 
cells, which results in an enlarged prostate gland. As a result the prostatic urethra is 
compressed, which restricts the flow of urine from the bladder. This interference with urine 
flow may cause uncomfortable symptoms such as frequency, urgency, nocturia, 
intermittency, decreased stream, and hesitancy. (Kapoor , 2012) 
      Benign prostatic hyperplasia, a histologic diagnosis, is a condition that occurs with aging; 
the prevalence increases from 25% among men 40 to 49 years of age to more than 80% among 
men 70 to 79 years of age. (Sarma amd Wei , 2012 ) 
      Many complications may be developed from BPH such as increased post-voiding residual, 
bladder diverticula or calculi, vesico-ureteral reflux, hydronephrosis, renal insufficiency, and 
urine retention. (Oelke et al., 2012) 
       Acute urine retention (AUR) is a common urological emergency that is characterized by 
sudden and painful inability to pass urine. The incidence of AUR in patients with BPH varies 
widely from 0.4% to 25 % (Kara and Yazici, 2014). 
       Management of AUR consists of immediate bladder decompression by catheterization 
usually followed by BPH-related surgery. The evidence that emergency surgery was 
associated with an increased mortality and a higher rate of postoperative complications, and 
the potential morbidity associated with prolonged catheterization have led to an increased use 
of a trial without catheter (TWOC) (McNeill, 2006). 
         Trial without catheter (TWOC) is preferable compared with leaving the catheter in place, 
and a 23-28% success rate has been reported. Nevertheless, most patients still require TURP, 
either as an emergency or elective surgery (Taube and Gajraj, 1989). 

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         Alpha-1 (α1)-blockers decrease smooth muscle tone in the prostate, thereby rapidly 
improving urinary symptoms and flow. Currently available α1-blockers include the selective 
α1-blockers terazosin, doxazosin and alfuzosin and the highly selective α1A-blocker 
tamsulosin and silodosin. These agents have comparable efficacy, and the major differences 
between these agents are their tolerability profiles. (Montorsi  and Moncada , 2006). 
        All these agents produce their effects on voiding within hours of administration, 
regardless 
of 
prostate 
size 
without 
altering 
serum 
prostate 
specific 
antigen 
(PSA) or volume (Irani , 2006) 
       The alpha(1A)- and alpha(1D)-adrenoceptor antagonist tamsulosin, given at a 
dosage of 0.4 mg once daily in a modified-release formulation, is effective and 
well tolerated in the treatment of LUTS associated with BPH. Although the drug 
has been directly compared to date with one other agent only, data show overall 
that tamsulosin clearly offers advantages over other alpha(1)-adrenoceptor 
antagonists in terms of the need for a single daily dose only, and its low potential 
for hypotensive effects or interference with concomitant antihypertensive therapy. 
Dosage titration at the start of treatment is not necessary. Tamsulosin has a rapid 
onset of action and is effective in patients with moderate or severe symptoms. The 
drug is therefore a valuable therapeutic option, with both demonstrated and 
potential advantages over older nonselective agents, in the management of patients 
with LUTS associated with BPH.( Dunn CJ et al.,  2002) 
        By decreasing the resistance, α1-blockers can help relieve AUR and improve the chances 
of successful TWOC. (McNeill , 2001) 
        Longer catheter duration significantly increases the risk of complications such as urinary 
tract infections, urine leak and catheter obstruction and urethral stricture, all efforts should be 

 3
made to try to minimize the duration of catheterization and so reduce co-morbidity and 
healthcare costs (Fitzpatrick et al., 2011). 
        However, the optimum duration of therapy has not been fully assessed, and there is 
controversy regarding the length of time a catheter should remain in situ during the initial 
therapeutic phase. (Kara and Yazici , 2014 ) 

 4
AIM OF WORK 
The aim of this work is to compare between early (3days) and late(7days) removal 
of urinary catheter after acute urine retention in patients with Benign Prostatic 
Hyperplasia under Tamsulosin treatment.  

 5
PATIENTS AND METHODS 
         It is a prospective randomized study  that will be performed on 60 male patients 
with acute urinary retention(AUR) secondary to Benign Prostatic Hyperplasia(BPH) 
having their first attack. 
         All patients will be catheterized and the urine volume will be assessed and 
subjected to culture and sensitivity tests. After catheter insertion, the patients will 
receive prophylactic dose of  levofloxacin 500 mg  once and they will be divided 
randomly into two groups: 
Group I: 30 patients will receive Tamsulosin hydrochloride 0.4 mg once daily and the 
catheter will be removed after 3 days. 
Group II: 30 patients will receive Tamsulosin hydrochloride 0.4 mg once daily and the 
catheter will be removed after 7 days. 
Exclusion criteria:  
1) Renal impairment.
2) Suspected urethral stricture.
3) Neurogenic bladder.
4) Cancer prostate.
5) Medically induced retention.
6) Previous use of alpha blockers.
7) History of drug hypersensitivity or allergy to Tamsulosin.
8) Chronic retention.

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Inclusion criteria: 
Patients having first attack of acute urinary retention secondary to BPH. 
Patients Evaluation: 
1) All patients will be subjected to complete medical history with stress on lower
urinary tract symptoms (LUTS) before acute urine retention (AUR) using
International Prostate Symptom Score (IPSS) .
2) Detailed past medical and operative history will be taken.
3) Complete physical examination will be carried out including Digital Rectal
Examination (DRE).
4) All patients will be subjected to Pelvi-Abdominal Ultrasound and estimation of
prostate size.
5) Follow up :
A. Complications 
related 
to 
catheter 
such 
as 
hematuria, 
obstruction, 
Urinary leakage and urinary tract infections will be recorded in the 
two groups. 
B. After catheter removal, patients will be  allowed to void and will be 
discharged home who will have a successful void more than 200 cc of 
urine. Patients who will fail to void will be  re-catheterized and 
will be prepared  for prostatectomy. 
C. Two weeks after catheter removal : 
- All patients will be subjected to: 
Pelvi-abdominal ultrasound with  estimation of post voiding residual    urine .
Uroflowmetry.
Urine analysis ,urine culture and  sensitivity tests.

Prostatic specific  antigen (PSA).
D. Six  weeks after catheter removal: 

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- The previous investigation will be repeated. 
Statistical Methods:  
   The numerical data will be statistically presented in terms of range, mean, standard 
deviation, median and interquartile range (IQR). Categorical data will be summarized 
as percentages.  
  Comparisons between numerical variables of two groups will be done by Student’s 
unpaired t-test for parametric data . (Mahadik, et al.,2013) 
  Comparing categorical variables will be  done by Chi-square test or Fisher exact test 
for small sample size.  
  Correlations between various variables will be done using Pearson moment correlation 
equation for linear relation, P-value will be considered significant when P-values less 
than 0.05. (Desgrandchamps F et al., 2006) 

 
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