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Diethylstilbestrol 1?mg in the Treatment of Acute Urinary Retention due to Prostatic Obstruction in the Elderly: A Preliminary Study

DOI: 10.1155/2014/984382

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Abstract:

Patients who failed a catheter-free trial after acute urinary retention and one week of full dose alpha-blocker and 5-alpha-reductase inhibitor were offered Diethylstilbestrol 1?mg plus Aspirin 100?mg over 4 weeks. Prostate volume, age, serum creatinine, and initial retention drained urine volume were recorded. After excluding cardiovascular morbidity ( ), upper urinary tract dilation ( ), compromised renal function ( ), urinary tract infection ( ), neurological diagnosis ( ), or preferred immediate channel transurethral resection of prostate ( ), 48 of 69 consecutive patients ≥70 years were included. Mean age was 76.6 years (70–84), mean prostate volume 90?cm3 (42–128), and mean follow-up 204 days; 58% (28/48) were passing urine and 42% (20/48) were catheter dependent after 4 weeks Diethylstilbestrol trial. Mean age and drained urine volume of catheter dependent patients were 82.4 years and 850?mL compared with 74.6 years and 530?mL in catheter-free men, respectively. Age and drained urine volume were independent predictors of catheter-free trial (both ). Seventy-five percent (6/8) of patients 80 years and older were catheter dependent. Transient nipple/breast tenderness and gynecomastia were the only adverse effects reported by 21% (10/48) and 4% (2/48), respectively. No patient presented severe complications. 1. Introduction Acute urinary retention (AUR) is an important urological emergency in men [1–3]. It is characterized by a sudden and painful inability to pass urine voluntarily [1, 4]. Approximately 10% of men aged 70 and a third of men aged 80 will have an AUR in the next 5 years [5]. Management of AUR consists of immediate bladder decompression by catheterization. The method and duration of catheterization as an initial treatment are primarily dependent within and among the countries, as is the decision to admit or send home after catheterization [1, 6, 7]. Usually, standard management of nonhigh pressure acute retention is alpha-blocker for at least 48 hours followed by trial without catheter (TWOC) [6, 8, 9]. Subsequent handling is not well filed due to lack of guidelines, mainly in those who fail TWOC [1]. This study aims to evaluate efficacy, safety, and adverse effects of DES 1?mg plus aspirin 100?mg over 4 weeks as a minimally invasive alternative in an elderly population presenting with AUR secondary to prostatic obstruction who failed a catheter-free trial. 2. Methods After local ethics committee approval and patient consent, men over 70 years, age in an outpatient clinical setting presenting prostatic obstruction with AUR and who

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