Long term follow up of men with Alfuzosin who voided successfully following acute urinary retention*.

INTRODUCTION: Acute urinary retention (AUR) is one of the commonest causes of admission in urology ward and successful voiding with alpha-blockers has been reported. However, long-term efficacy of Alfuzosin, following an episode of AUR is lacking. This is a continuation of our earlier reported study. We report the results of a 4 year follow-up on patients who were on Alfuzosin SR 5 mg BD, following resumption of voiding after an episode of AUR. PATIENTS AND METHODS: A total of 33 patients voided successfully following AUR in our original study. These patients continued on Alfuzosin SR 5 mg BD and were assessed at 2 and 4 years. Symptomatic assessment was performed with IPSS and QOL symptom score and objective assessment was with urinary flow rate and post void residual volume. Patients who continued to deteriorate symptomatically and objectively or developed further AUR were listed for surgery. RESULTS: Out of 33 patients, 28 patients were followed up at 2 years (three patients died due to various medical reasons and two did not attend for follow-up). Nineteen patients (68%) underwent transurethral resection of prostate (TURP) for severe lower urinary tract symptom (LUTS) . The mean peak flow rate at 2 years was 8.4 ml/s and the mean residual volume was 112 ml. Ten patients attended for follow up at 4 years. The mean flow rate was 5.17 ml/s and the mean post-void residual volume was 101 ml. Four patients underwent TURP for severe outflow symptoms. At 4 years follow up 24 out of 30 patients (80%) on Alfuzosin needed TURP. CONCLUSIONS: These data do not support the long term use of alpha-blockers in patients who voided successfully after acute urinary retention.

Randomised, placebo controlled, double blind study of alfuzosin SR in patients undergoing trial without catheter following acute urinary retention.

INTRODUCTION: Acute urinary retention caused by bladder outlet obstruction resulting from prostatic enlargement is one of the commonest causes for acute admission to urology wards. More recently, there has been a trend to commence treatment with alpha-blockers after catheterisation followed by a trial without catheter (TWOC), in the hope that surgery may be avoided in a significant proportion of patients. There is no conclusive evidence of the efficacy of this treatment. We conducted a study to evaluate the efficacy of using the alpha-blocker alfuzosin SR in patients with acute urinary retention. PATIENTS AND METHODS: All patients presenting with acute urinary retention to our unit were included in the trial. Exclusion criteria included patients with known bladder or prostate malignancy, bladder calculi, urinary tract infections, urethral stricture or patients on alpha-blockers. A total of 81 patients consented and were randomised. Sixty-two patients completed the study. The retention volume was recorded. Trial medicine was recorded on a twice-daily dose and the first TWOC was carried out after a minimum of three doses or 36 hours after admission. TWOC was considered successful on voiding with a residual volume of <200 ml. Unsuccessful patients were recatheterised and discharged home on trial medication, and called for a second TWOC after 2 weeks. Successful patients were continued on alpha-blockers and failures were put on the operating list for TURP. Patients on active treatments were reviewed at 2 year. RESULTS: Of the 34 patients treated with alfuzosin SR, 17 (50%) resumed voiding and of the 28 patients from placebo group, 16 (57%) voided successfully. All 33 patients were continued open labelled on alfuzosin SR 5mg BD. Out of 33 patients, 13 (43%) had TURP within first year after TWOC and three died due to various medical causes. Out of remaining 17 patients, 15 attended for follow-up. The mean peak flow rate was 8.4 ml/s and the mean residual volume was 112 ml. Six patients (40%) required TURP for severe lower urinary tract symptoms (LUTS). So out of 28 patients followed at 2 year, 19 (68%) had TURP. CONCLUSIONS: These data do not support the routine use of alpha-blockers in patients with acute urinary retention. Also continuing use of alpha-blockers does not seem to prevent further requirements of TURP, although larger studies are needed to support this.

The role of percutaneous nephrolithotomy in the management of pediatric renal calculi.

PURPOSE: Minimally invasive techniques for the treatment of urinary calculi in children are recommended due to an increased probability of recurrence. Percutaneous nephrolithotomy is well established in adults but to our knowledge this procedure has not been reported previously in a large series of children. We review our experience with percutaneous nephrolithotomy in children. MATERIALS AND METHODS: From 1987 to 1995 percutaneous nephrolithotomy was performed in 25 children 3 to 16 years old (median age 8). Indications for percutaneous nephrolithotomy were an obstructed kidney in 10 cases, large stone size or staghorn calculus in 8, failed extracorporeal shock wave lithotripsy in 4 and residual stones after open surgery in 3. There were 15 solitary renal, 4 staghorn and 2 upper ureteral stones, and 5 children had multiple renal calculi. RESULTS: Percutaneous nephrolithotomy was performed once in 22 patients, and 2, 3 or 5 times in the remainder. Of the 25 patients 17 (68%) were stone-free at hospital discharge or shortly thereafter following a single session of percutaneous nephrolithotomy. Retained calculi after a single percutaneous nephrolithotomy treatment were much more common with staghorn stones (2 of 4 cases or 50%) and multiple stones (3 of 5 or 60%) compared to solitary renal stones (2 of 15 or 13.3%). With subsequent extracorporeal shock wave lithotripsy or repeat percutaneous nephrolithotomy the stone clearance rate was as high as 92%. At a 2 to 66-month followup (average 23) no late complications were noted. Radioisotope scans available in 10 cases before and after percutaneous nephrolithotomy revealed unchanged differential function and evidence of significant renal scars in only 1. CONCLUSIONS: Percutaneous nephrolithotomy is a suitable and safe procedure for treating renal stones in children.