Management of acute urinary retention in men with benign prostatic hyperplasia: Literature review and guidelines from the French Urological Association Male LUTS Panel (CTMH)

Acute urinary retention (AUR) is a common urological emergency, particularly in elderly men, often associated with benign prostatic hyperplasia (BPH). It requires prompt intervention to relieve symptoms and prevent complications. The French Urological Association Male LUTS Panel (CTMH) aimed to develop evidence-based guidelines for managing BPH-related AUR in men.

A systematic PubMed literature review was conducted, evaluating studies by level of evidence and methodological quality. Guidelines were developed through CTMH member consensus.

Drainage method selection (urethral or suprapubic catheter) should consider patient-specific contraindications. Suprapubic catheterization may offer superior patient comfort and reduced colonization rates. Clean intermittent self-catheterization represents a viable alternative with improved quality of life. Alpha-blockers (alfuzosin 10mg, tamsulosin 0.4mg, silodosin 8mg) administered for 2-3days significantly improve trial without catheter success rates, with no agent demonstrating superiority. Short catheterization duration (<3-5days) reduces complications without compromising outcomes. Perioperative AUR prevention may benefit from tamsulosin in high-risk patients (spinal anesthesia, previous AUR, age>60, known BPH). Evidence remains insufficient to recommend immediate surgery without trial without catheter or to establish optimal surgical technique.

These CTMH guidelines provide evidence-based recommendations for AUR management, emphasizing alpha-blocker therapy before trial without catheter and considering patient-specific factors when selecting drainage methods. Further research is needed to optimize surgical timing and technique selection.

Published by The French journal of urology, 2025. The guideline itself is at the source linked here.

doi.org/10.1016/j.fjurol.2025.102953