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Is the conservative management of chronic retention in men ever justified?

Created: 7/9/2006
Updated: 7/9/2006


Is the conservative management of chronic retention in men ever justified?
T.S. Bates, M. Sugiono, E.D. James, M.A. Stott, R.D. Pocock
BJU Int 2003 Oct ; 92: 581-583


  • Flow clinics and measurement of postvoid residual urine volume (PVR) has been recommended by the WHO International Consultation on BPH in 1995 for patients with LUTSFew studies assessing the natural history of lower urinary tract dysfunction exist
  • No long-term, prospective studies of the natural history of men with large PVR’s have previously been published


  • The study included men presenting with LUTS and a PVR of > 250 mL who, because of significant comorbidity, a low symptom score or patient request, were managed conservatively
  • They were prospectively followed-up with symptom assessment, serum creatinine levels, flow rates and renal ultrasonography.
  • Patients were actively managed if there was a history of previous outflow tract surgery, prostate cancer, urethral strictures, neuropathy, elevated creatinine or hydronephrosis.
  • 93 men (mean age 70 years, range 40–84) with a median (range) PVR of 363 mL (250–700) were included in the study and followed for 5 (3–10) years
  • At presentation, the median maximum flow rate was 10.2 (3–30) mL/s and the voided volume 316 (89–714) mL


  • The measured PVR remained stable in 47 (51%), reduced in 27 (29%) and increased in 19 (20%) patients
  • 31 patients (33%) went on to transurethral resection of the prostate after a median of 30 (10–120) months, because of serum creatinine elevation (two), acute retention (seven), increasing PVR (eight) and worsening symptoms (14)
  • Of 31 patients 25 were available for evaluation after surgery; their median PVR was 159 (0–1000) mL, flow rate 18.4 (4–37) mL/s and voided volume 321 (90–653) mL Symptoms were improved in all but five men
  • There was no difference in initial flow rate, voided volume or PVR between those who developed complications or went on to surgery and those who did not
  • Urinary tract infections (UTIs) occurred in five patients and two developed bladder stones


  • The most consistently reported indication for the measurement of PVR is to detect those patients at risk of developing hydronephrosis and renal impairment
  • During a mean follow-up of 5 years, only two patients developed abnormal creatinine levels and in both they returned to normal after catheterization and TURP
  • The 11% rate of acute retention in the present study is higher than that of the placebo group in the PLESS study suggesting that chronic retention predisposes to this condition
  • We found symptomatic UTIs to be uncommon and occult neurological disorders are an unusual cause of large PVRs
  • Long-term follow-up of a randomized study of TURP vs watchful waiting in patients with moderate LUTS showed that 27% of men underwent TURP after a mean follow-up of 3.6 years
  • The commonest indication for surgery in this group was deteriorating symptoms. Other indications included an increase in the PVR to > 350 mL (7%), acute retention (3%) and a doubling of creatinine levels in one patient (0.3%)
  • As in the present study, measurements used at presentation could not identify those patients likely to develop complications
  • Surgical outcomes in patients who failed watchful-waiting were good but evidence exists that there may be a detrimental effect of delaying surgery, presumably as a result of detrusor changes over time


  • Renal failure, acute retention, recurrent UTIs and bladder stones are not commonly associated with chronic retention
  • The presence of a large PVR alone does not necessitate surgery.
  • There were no factors at presentation that could be used to predict those patients who eventually developed complications or required surgery

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