Urethral catheterization followed by a trial without catheter (TWOC) has become a standard treatment worldwide for men with benign prostatic hyperplasia (BPH) and acute urinary retention (AUR).

In addition, prescribing an alpha-1 blocker prior to TWOC approximately doubles the chance of therapeutic success, and prolonged catheterization is associated with increased morbidity.

These are the conclusions of John Fitzpatrick, MD, and colleagues after they studied data from 6,074 patients and 953 urologists from public, private, and mixed health-care practices in France, Algeria, and 13 other countries in the Middle East, Asia, and Latin America.

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As reported online ahead of print in BJU International, 71% of patients had spontaneous AUR and 29% had experienced AUR following a triggering event, mainly anesthesia administration or excessive alcohol intake. A urethral catheter was inserted in 89.8% of cases, usually followed by a TWOC (78%) after a median of five days.

The overall TWOC success rate was 61%. Most men (86%) received an alpha-1 beta-blocker (usually alfuzosin) before catheter removal with consistently higher TWOC success rates, regardless of age and type of AUR.