CLINICAL OUTCOMES OF TRIAL WITHOUT CATHETER IN ACUTE URINARY RETENTION DUE TO BENIGN PROSTATIC ENLARGEMENT: A 24-HOUR VERSUS 5 DAY APPROACH

Syed Muhammad Ali Hasnu¹, Farhan Ahmad¹, Jawad Khan¹, Jasim Khan¹, Zahid Ullah Khan², Muhammad Nasir Jamil¹

• Ayub Teaching Hospital, Abbottabad

• Institute of Kidney Diseases, Peshawar

CORRESPONDING AUTHOR: DR JASIM KHAN, Trainee Registrar, Ayub Teaching Hospital Abbottabad.

SUBMISSION DATE: 01/01/26, ACCEPTANCE DATE: 06/01/26, PUBLICATION DATE: 12/01/26

Vol 04, Issue 03

ABSTRACT:

Introduction: In older men, benign prostatic hyperplasia (BPH)-induced acute urine retention (AUR) is a urological emergency. The best time to remove a catheter is still up for debate, despite the fact that Trial without Catheter (TWOC) is currently a common conservative technique. While delayed TWOC (after 5 days) may increase success rates by enabling greater recovery with α-blocker medication, early TWOC (after 24 hours) may lower infection risk and hospital stay.

Materials & Methods: This non-randomized controlled study was carried out at the Ayub Teaching Hospital’s Department of Urology in Abbottabad between October 2025 and December 2025. 186 patients with acute urinary retention between the ages of 50 and 80 years were included. Patients with severe bladder or urethral abnormalities (such as strictures, stones, pelvic injuries, acute prostatitis, or cancers), neurogenic bladder or other neurologic diseases that impair bladder function, deranged renal function tests, and contraindications to TWOC were not included. Patients were split into two groups according to hospital protocol and doctor discretion rather than at random. Trial without Catheter (TWOC) was performed on patients in Group A 24 hours later, and on patients in Group B 5 days later. To evaluate the effectiveness of TWOC, the post-void residual (PVR) volume was measured after the procedure, and the need for re-catheterization was recorded.

Results: A statistically significant difference was seen in the TWOC success rate, which was 52.69% in group A and 69.89% in group B (p = 0.096). However, group B experienced considerably more problems, including urine leakage, infection, hematuria, and catheter blockage (40.86% vs. 22.58%, p = 0.007).

Conclusion: After a urinary retention episode in BPE, the success rate of TWOC is found to be much higher with longer catheterization times. When the urinary catheter is removed on Day 5 of the retention episode, the chances of success are much higher than when it is removed on Day 1, although the risk of morbidity or catheter-related infections is not significantly increased. Keywords: acute urinary retention, benign prostatic hyperplasia, trial without catheter.