Significance of Repeat Trial Without Catheter in Patients With Urinary Retention Who Failed the First Attempt at Trial Without Catheter: A 10‐Year Retrospective Study

Introduction Trial without catheter (TWOC) is used to determine whether patients with acute urinary retention can achieve a catheter‐free status. In clinical practice, it is common to repeat TWOC in patients who fail to void without a catheter during the first TWOC attempt. We investigated the outcomes and significance of repeat TWOC in male and female patients and aimed to identify predictors of successful outcomes of repeat TWOC based on patient backgrounds. Material and Methods Patients with acute urinary retention who underwent TWOC at a single center between 2010 and 2019 were enrolled and retrospectively analyzed. In the TWOC, the urinary catheter was removed after the instillation of warm saline (200–300 mL), and residual urine was measured after the first void. The trial was defined as unsuccessful if the patient had difficulty in voiding because of abdominal discomfort or pain. The decision to repeat the TWOC in patients who failed the first trial was made by each physician. Patients were divided into the single‐trial and repeat‐trial groups, and clinical factors predicting successful outcomes for each TWOC were analyzed using a multivariate logistic regression model. Results Overall, 681 consecutive patients (577 male and 104 female) were diagnosed with acute urinary retention and underwent TWOC. Among the 577 male patients, 441 (76.4%) underwent TWOC only once (single‐trial group), and 136 (23.6%) underwent TWOC twice or more (repeat‐trial group). Among the 104 female patients, 84 (80.8%) and 20 (19.2%) underwent single and repeat TWOC, respectively. The overall success rate of TWOC for the single‐trial and repeat‐trial groups was not significantly different in either sex: 61.9% (273/441, single trial) and 55.1% (75/136, repeat trial) in male patients ( p = 0.159) and 58.3% (49/84, single trial) and 55.0% (11/20, repeat trial) in female patients ( p = 0.786). In the repeat‐trial group, no significant and independent predictor of successful TWOC was found. In the single‐trial group, low Eastern Cooperative Oncology Group performance status (odds ratio: 1.79 [1.1−2.9], p = 0.019) was identified as an independent predictor of a successful trial and absence of dementia (odds ratio: 3.82 [0.71−20.46], p = 0.118) was a possible predictor in male patients, whereas a high serum albumin level (odds ratio: 0.55 [0.27−1.15], p = 0.113) was a possible predictor of a successful trial in female patients. Conclusions This is the first study to show the importance of repeated TWOC in male and female patients. The equivalent success rate of TWOC in the single and repeat TWOC groups for male and female patients indicates that repeat TWOC is justified as well as single TWOC, suggesting the importance of attempting repeat TWOC in patients of both sexes. This study also showed that predicting successful TWOC based on patient characteristics is difficult in repeat TWOC, but may be possible in the first TWOC. Clinical Trial Registration: Our study is an observational study and not a clinical trial, so registration is not required.